By Jason Millman - 03/23/11 10:06 AM EDT
The battle over healthcare has barely slowed down one year to the day after President Obama signed the 2,700-page bill into law.
A year after his victory, Obama has seen the healthcare fight spread from the chambers of Congress to the states, the regulatory process, the judiciary and the court of public opinion.
Former Rep. Bart Stupak (D-Mich.), who played a pivotal role in winning over skeptical House Democrats to help pass the law by single digits last year, said he’s not surprised that healthcare reform remains as divisive as ever.
“Of all the legislation I ever voted on in my life, this is the one that will affect every man, woman or child,” he said in an interview with The Hill.
The split power between Republicans in the House and Democrats in the Senate set up an early battle over healthcare in budget negotiations. House Republicans voted to choke off implementation funds for the law in a long-term spending bill to keep the government running through September, but Democrats rejected the plan. After a series of stopgap bills to avert a government shutdown, neither party seems ready to budge.
A few conservative Republicans want to leverage the spending bill to block funds to implement the law, as well as $105 billion in required spending. “If a member votes for the continuing resolution, that vote effectively says, ‘I am choosing not to fight,’ ” said Rep. Michele Bachmann (R-Minn.).
Rebuffed in their efforts to repeal the law, House Republicans are singling out several provisions for elimination, including a long-term care insurance program, an independent payment advisory board, a tax on medical device makers and a regulation that insurance brokers and agents fear pushes them out of the marketplace. A handful of Democrats have signed onto some of the bills, but it’s too early to tell whether any will see the light of day in the Senate.
Even as Republicans mount healthcare challenges on numerous fronts, the House’s top Democrat said last week that she remains confident the law will stand.
“I feel pretty confident about it, because this is a very balanced bill, despite the misrepresentations that were made about it,” House Minority Leader Nancy Pelosi (D-Calif.) said this month during a subdued press conference marking the law’s one-year anniversary.
With Senate Democrats serving as a buffer for Republican repeal efforts, the administration’s major hurdle could be in the legal system. Three federal judges have ruled in favor of the law’s unpopular requirement for individuals to purchase insurance, while one judge struck down the entire law and another ruled against individual mandate.
With many of the cases on the fast track in appellate courts, legal observers believe the Supreme Court can issue a decision on the law’s constitutionality as early as June 2012, just in time to play a huge role in the presidential election.
Despite the lawsuits, the administration continues to pump out money to implement the law, even in states that are challenging the law in court. But the states are proving to be a fertile ground for opposition to the law.
To combat GOP claims that reform amounts to a government takeover of healthcare, the Obama administration has been eager to tout its willingness to bend some of the rules for those who can’t match the law’s rigorous requirements. But these efforts have opened the White House to even more criticism.
Republicans charge that the 1,000-plus organizations that have received a temporary exemption from the law’s new annual benefit requirements are proof the law doesn’t work, or that those exemptions are gifts to Democratic allies. That has put Democrats in the awkward position of defending bare-bones health plans they dislike in order to preserve stability in the insurance market.
“I find it ironic that people who are always demanding flexibility from the federal government are now criticizing flexibility in the federal government,” Department of Health and Human Services Secretary Kathleen Sebelius said in an interview with The Hill earlier this year.
But flexibility is exactly what Republican governors have demanded from the White House. They want their states to opt out of a healthcare reform requirement to maintain Medicaid eligibility standards through 2014 as they wrestle with massive budget shortfalls. And they want more flexibility to set up new health insurance exchanges, which open in 2014.
The administration made its greatest show of flexibility last month when Obama voiced his approval of a bill that would allow states to opt out of healthcare reform three years earlier than planned. The flexibility comes with a catch, though: States must hit access, coverage and affordability goals set by the federal reform. To Republicans, the plans amounts to a false promise of flexibility.
The battle between the nation’s governors and the White House indicates that the federal law faces as much of a battle at the state level as it does from Republican lawmakers. Local Tea Party groups in Georgia recently pressured the state government into blocking efforts toward setting up a health insurance exchange.
It’s a strategy that Jamie Radtke, leader of the Virginia Tea Party Patriots and a Senate candidate, endorses.
“Our ability to effect change at the state level is much greater, unfortunately, than our ability to effect change in Washington, D.C.,” Radtke told healthcare reform opponents last week.
But congressional Democrats aren’t backing down. After shying away from defending the law in the months following its passage, Democrats are fighting back by highlighting an array of consumer protections included in the law. And they frequently needle Republicans for failing to pitch an alternative comprehensive reform plan.
“We know they want to repeal — what do they have to offer?” Rep. Henry Waxman (D-Calif.) challenged last week.
Replacing healthcare reform with “common-sense solutions” was part of the Republican repeal pledge. GOP lawmakers have so far offered up longtime favorites, such as medical malpractice reform and opening health insurance across state lines, but their replacement agenda remains nebulous almost three months into the new Congress.
Efforts to defund and repeal the law have effectively delayed Republicans from putting forward more comprehensive replacement pieces, said Rep. Steve King (R-Iowa), who’s leading efforts to choke off funding for the law.
“It’s going to take some months before there’s the kind of public attention that can be drawn to replacement components,” King said last week.
The Republican House leadership doesn’t seem to be in any hurry to satisfy the latter portion of “repeal and replace.” In January, House Speaker John Boehner (R-Ohio) said there was no need for “artificial deadlines” to set a replacement plan.
Healthcare promises to stay front and center on the national stage over the next two years as Republican candidates line up against Obama and one of their own. Possible Republican contenders have gleefully piled on Mitt Romney’s backing of an individual mandate as governor of Massachusetts — a provision they say hews too closely to the federal reform.
Meanwhile, the one provision that everyone agrees must be scrapped remains in limbo due to a partisan squabble over funding its repeal. Both chambers this year have easily passed a repeal of the so-called 1099 reporting requirement on businesses, but most Democrats, including the White House, have major concerns that the House pay-for will keep people away from signing up for new state-run health insurance exchanges created by healthcare reform.