The Debt Ceiling, Republicans and Obamacare

The current efforts of House and Senate Republicans to tie the Patient Protection and Affordable Care Act (ACA) to the debt ceiling vote (and any other budget bill they can think of), is the worst sort of political gamesmanship and frankly, amounts to extortion. The ACA was developed over a period of years, with health industry lobbyists influencing the outcome, and is a law, not a policy. No, it was not a bipartisan effort (and we would be much better off if it were), but now is not the time to discuss how that came about.

If Obamacare needs adjustment (or even replacement), the discussion should be handled through a thoughtful legislative process that gives the topic the attention that it requires. After all, if it is as bad as Republicans claim (it isn’t – a similar system was designed and implemented by Republicans in Massachusetts), it will take a major effort to come up with a replacement.

The Republicans don’t mention it, but the private sector has already invested billions in developing solutions that comply with the provisions of Obamacare – and plan to make a profit on it. Check the discussions taking place in professional organizations such as HiMSS (www.himss.org) and ATA (www.americantelemed.org).

The Republicans also are slow to acknowledge that healthcare costs were increasing at an alarming rate before Obamacare was conceived, and this cost escalation was seen as a threat to the U.S. economy. A stated purpose of the Act was to slow the growth of healthcare costs in the United States, while expanding healthcare coverage to most citizens. To be sure, the initial claims of savings for families were over-promised. A recent Forbes article quotes MIT economist Jonathan Gruber as saying, “. . . Obamacare will raise national health spending by 1 to 2 percent.” And “This is a small fraction of the typical 5 to 7 percent annual growth rate in health care – and is a small price to pay for insuring 30 million or more Americans.”

The one-year delay in implementation of the ACA being proposed is blatantly transparent: get through 2014 and the Republicans hope to gain enough legislative seats to engineer a total repeal of the law. However, there are 30 million or so voters out there who may not take kindly to having their health coverage taken away.

Let’s do the right thing: vote on the debt ceiling increase without the ACA conditions. Then, set up a Congressional Conference Committee to look at the ACA and propose changes that will fix its problems. I optimistically assume here that both parties are participating in good faith. If this opportunistic effort to defund Obamacare is simply an attempt by Republicans to deny President Obama an achievement, then they will have no interest in a Conference Committee or any other mechanism that might yield a real solution to the problem of healthcare costs and availability.