Americans may or may not agree on meteorological climate change, but on the subject of political climate change there is universal agreement. On Nov. 4, Democrats got cooler and Republicans hotter. No matter the discussion about whether voters were casting ballots for the lesser of two weasels or whether it was an anti-status quo vote, the overall temperature has now been raised – especially on Republicans.
Now that the climate has changed, the question in our industry regards the course that should be taken when it comes to the Patient Protection and Affordable Care Act (PPACA). Some insist on (yet another) symbolic vote to repeal the law. Seriously? If nothing else was clear from the mid-term election, voters are tired of the empty calories of unproductive legislative adventures.
A pyrrhic victory on such an action will cause further annoyance among voters and will cast the Republicans in the role of antagonists; neither of which are results that will help them with the 2016 campaign, which is (or ought to be) forefront in their thinking.
They need to pivot from being tactical to being strategic. In the process they need not abandon their core beliefs, but a bit of pragmatism added to the mix will go a long way toward assuaging voter’s worst fears.
Unless the Senate has a lock on overturning the certain presidential veto of a repeal vote, they should think very carefully about stepping off that ledge. Sen. Mike Lee, incoming chairman of the Senate Steering Committee, cautions that his party needs to adopt a “Show We Can Govern” strategy.
To achieve that end, the 114th Congress must focus their PPACA energies on reforms that can achieve bipartisan consensus. If the president vetoes such measures, he will do so at his administration’s – and more importantly, his parties’ – peril.
So what next? Look for ideas that can achieve that consensus and that the president is likely to sign. That shows legislators who can govern, which is what Americans keep saying they want.
My friend, the redoubtable Donna Hill, suggests eliminating the medical device tax and the “Cadillac tax.” “The latter never made much sense anyway,” she says. “Essentially, the very people who were saying ‘the health plans offered today are inadequate’ are now saying, ‘but don’t make them too good or we’ll punish you.’”
Avik Roy of the Manhattan Institute went further than ideas that might garner bipartisan support and suggested some measures he believes the president would sign. Among them are removing regulations that drive up costs, such as a change to the PPACA regulation that requires insurers to pay for expensive brand-name drugs even if a generic would work, and repealing the employer mandate which, he believes, pushes more employees into part-time work.
However tempting it may be to ponder PPACA crumbling under the weight of a decision in favor of the plaintiffs in the federal vs. state exchange subsidy battle (King v. Burwell) it would serve well to remember that exercises of convenient regulatory legerdemain (as we have seen in the past) might resolve the issue in a way that preserves the status quo. In the end, most changes will have to come from Congress.
John Greene, vice president of congressional affairs for the National Association of Health Underwriters, cautions about expecting too much, too soon. “There is pent up desire to clear the decks of low lying fruit on which all sides can essentially agree to address on a host of issues,” he has said. “There is only likely to be one early health care vehicle leaving the station and that is the [sustainable growth rate] or doc fix that expires in March 2015.”
As the next Congress gets down to business we will see if they heed the advice of Senator-elect Cory Gardner (R-Colo.) who told his party that, “If we can’t govern with maturity and competence, two years from now we will see a wave in the other direction.” Political climate change can chill just as quickly as it has warmed.