In Bergthold's view, enough Americans will like some provisions of the reform law by 2012 that it will be impossible to repeal it, even if the GOP adds control of the White House and the Senate to its takeover of the House of Representatives. Those provisions include preventive care without copayments, state high-risk pools for the uninsurable, no pre-existing condition exclusions for kids, no annual lifetime limits on insurance, coverage for young adults on their parents' plans, and the closing of the "doughnut hole" in Medicare drug coverage. Well, maybe so. But let's not forget, six in 10 voters on Medicare pulled the lever for Republicans earlier this month.
Bergthold admits that the Republicans may well defund or block reform elements that are important to cost control, as I've pointed out before. But in her mind, the biggest obstacle to the Affordable Care Act's repeal in 2012 is that the Republicans offer precious little to replace it with. I agree that ideas like selling insurance across state lines, malpractice reform, and consumer-directed health plans are totally inadequate to cope with our healthcare crisis. But allow me to point out how the Republicans might try to co-opt the debate if they regain power.
Minnesota Gov. Tim Pawlenty, who is widely expected to run for President in 2012, has taken such a strong stand against Obamacare that it will be difficult for even dyed-in-red Tea Partiers to attack him. In August, Pawlenty signed an order directing state agencies to decline all discretionary participation in the reform law. That means they can't apply for grants or demonstration projects authorized by the Affordable Care Act. Pawlenty has also said he opposes the expansion of Medicaid to 250,000 Minnesotans, which he claims would cost the state $430 million in the first three years. (As Maggie Mahar recently observed with regard to a similar claim by Texas conservatives, this is nonsense, since the federal government is paying 100 percent of the additional cost through 2019.)
But, though this is little known nationally, Pawlenty in 2008 signed a state healthcare reform bill that had many of the same goals that the national legislation has. Among other things, the law:
- Expands eligibility for a state-subsidized insurance program to adults without children to 250 percent of federal poverty and parents with incomes up to $57,500 annually.
- Promotes the use of "health homes" to coordinate care for people with chronic diseases, including standards for state certification and state and private incentives.
- Establishes a single statewide system of quality-based incentive payments to be used by public and private health care purchasers.
- Promotes transparency and accountability by establishing "baskets" of health care services to allow consumers to more easily compare cost and quality of care across providers, and to promote provider innovation on cost and quality.
The point is that if Pawlenty were elected president and urged repeal of the Affordable Care Act, he has some plausible proposals to make for replacement legislation. Of course, his record on healthcare is far from stellar -- in fact, several times he purloined money that the Minnesota legislature had earmarked for healthcare to fill the state budget gap. But, unlike ideologues such as Mitch McConnell, John Boehner and Eric Cantor, Pawlenty might be flexible enough to take a bipartisan stance that will pull in some congressional Democrats.
Of course, two years is a long time, and Pawlenty is far from becoming president. But let's not dismiss the "repeal and replace" scenario just yet.
Image supplied courtesy of Flickr.