Politics: Will Health Care Reform Happen?

TORONTO, ONTARIO - In an unusual Saturday session, the United States House of Representatives actually passed a health care reform bill, the so-called Affordable Health Care for America Act, on 7-November-2009 by the narrow margin of 220-215. Much of the media discussion has focused on the immediate challenges for the health care reform effort, namely trying to find a compromise bill that can actually pass both the House and the Senate. However, I think the long-term challenges for the bill to actually be implemented may be much greater, and I find it surprising that nobody is talking about that reality.

The first thing that strikes out at me is that the bill passed by the House has most of its provisions actually take effect in 2013. Having time to transition into a new system, rather than creating problems by shocking the system, makes sense. However, looking at what has happened with recent credit card legislation is instructive--credit card companies used the time before the new rules took effect to drastically hike fees and rates on customers. Health insurance companies, who have in a very real sense only been held in check by the threat of reform, will no longer have any reason to hold back on increases, and will try to make all the money they can before 2013.

Of course, there are two elections before 2013. If Republicans are smart, they will campaign in 2012--however untruthfully--that health care premium increases in 2010, 2011, and 2012 were the fault of health care reform and promise to repeal the legislation. It seems entirely conceivable to me that this could be an effective campaign theme and lead to Republican majorities in the House, Senate and retaking the White House in 2012. While it would be very difficult for the Republicans to get a filibuster-proof 60 seats in the Senate by 2012, a clear landslide in their direction would probably bully the Democrats into not filibustering, and repeal could occur.

Even if the Democrats hang on to at least one chamber and prevent repeal of the legislation before it takes effect, there is another method that the opposition will undoubtedly use. Christian Scientists will be supported in what, based on the current legislative language, will be an inevitable effort to have the act declared unconstitutional. They will argue that it is unconstitutional for the government to require them to purchase an insurance policy that is of no use to them, as they do not partake of most health care services. Whether a valid constitutional argument or not, I would fully expect the current conservative-dominated Supreme Court--likely still to be in place when a hypothetical case might get there--to use the case as an excuse to issue a very narrow ruling overturning the legislation.

Those on the right go to great lengths to support their positions politically, showing in my lifetime a take-no-prisoners, no-compromise attitude that liberal Democrats frankly do not understand. If supporters of health care reform think they will not face that kind of action-oriented opposition even after legislation is passed, they are insane. They need to ensure that in their immediate efforts of trying to write legislation that can actually pass both chambers that the resulting language will stand up to a court challenge and cannot easily be reversed in early 2013. Otherwise, all their current efforts will have proven to be an incredible waste of energy.