National Journal’s Ron Brownstein makes an important point about health care — even if the Democratic reform bill is signed into law, Republicans are likely to try to repeal it if they take back the White House in 2013:
If Obama does sign a reform bill, which appears more likely than not, Republicans will face a momentous choice between consolidation and repudiation — between accepting the new program and seeking to dismantle it. The alternative paths are neatly captured by the GOP’s contrasting reactions to the two central cords of America’s existing social safety net. After FDR got Social Security approved in 1935, Alf Landon, his Republican challenger in 1936, denounced it as “unjust … stupidly drafted [and] … folly.” Roosevelt’s landslide victory over Landon (and subsequent re-elections) provided Social Security the time to build impregnable support. But many congressional Republicans kept fighting the program until President Eisenhower, a Republican, declared a truce after his election in 1952.
By contrast, Republicans largely accepted Medicare soon after President Johnson signed it into law in 1965. Although conservative Republicans such as Barry Goldwater and Ronald Reagan had fiercely condemned the program before its creation, Nixon during the 1968 campaign spared Medicare from his criticism of the Great Society’s cost. Once elected, he quickly “became a strong supporter of Medicare” and effectively ended challenges to its existence, Morone notes.
Which path might Republicans follow if Obama signs universal health care? Several factors point toward confrontation. The GOP accepted Medicare so quiescently partly because the program began dispensing benefits just one year after passage and rapidly became too popular to assail. Social Security, though, was phased in over many years–as health care reform is slated to be. Such delay can invite “fierce and protracted … guerrilla war,” notes Harvard sociologist Theda Skocpol.
Also encouraging confrontation is the breadth of Republican opposition. Almost all House Republicans at the time voted to derail Medicare and Social Security by “recommitting” the bills to committee. But once those challenges failed, about half of House Republicans backed Medicare on final passage and four-fifths supported Social Security. House Republicans last week voted 176-1 against the health care bill.
Some senior House Republicans have already pledged to repeal any health care bill if they regain the majority. And many GOP challengers in 2010 will surely echo them. But with Obama holding a veto pen, Republicans probably couldn’t mount a real threat unless they won the White House in 2012. One top adviser to a possible 2012 GOP presidential contender says that, given the GOP base’s hostility to the reform plan and independents’ unease, it is likely that “most potential [Republican] candidates will argue for wholesale replacement with their own version of health care reform.”
If Obama passes health reform and Republicans then seek its repeal, the next presidential election could lastingly redefine America’s social safety net. Like 1936 and 1968, 2012 looms as a crossroads in the relationship between Americans and their government.
Specifically, the bill defers the insurance subsidy system and the health insurance exchange until 2013, From a political perspective, it would presumably make more sense to deliver all of the bill’s benefits before the election that could decide its fate. So why is the bill structured this way? Here are a few possible reasons:
1. Deferring implementation until 2013 limits the costs of the bill under Congressional budget rules.
2. It avoids embarrassing implementation problems taking place during the campaign.
3. Setting up the health insurance exchanges is technically difficult and will take several years.
4. Despite the plan’s bad poll numbers, Democrats want the 2012 election to be about health care (a traditionally favorable issue).
In any case, even if Republicans gain ground in Congress and take back the White House in 2012, they would still have to defeat a Democratic filibuster in the Senate to repeal the bill. The odds of all those things happening aren’t especially high. But given the strength of the conservative base, we should expect a long GOP guerrilla war to try to weaken and undermine the program if it does in fact pass. This issue isn’t going away any time soon.
Update 11/17 12:46 PM: Matthew Yglesias clarifies an important point that I wasn’t clear about — a GOP effort to “repeal” health care reform wouldn’t necessarily eliminate every provision of the enacted legislation. However, from the standpoint of Democrats and advocates of reform, the changes Republicans are likely to propose would almost surely be seen as gutting the legislation.
Update 11/18 5:16 PM: The Kaiser Family Foundation has posted a useful summary of the House bill that includes implementation dates for key provisions.