PPACA: 2 or 3 possible end games

Ezra Klein’s Washington Post column reports three possible outcomes for the Patient Protection and Affordable Care Act (PPACA) from a speech by public opinion scholar Lawrence Jacobs. In order of likelihood they are:

  1. Resistance: like Social Security, which was fought over for years before becoming generally accepted
  2. Repeal: where the law is overturned under a new Administration and Congress. The Catastrophic Health Care Act of 1988 is the example provided
  3. Redemption: where PPACA follows the path of Medicare, which was initially fiercely fought but quickly became accepted

This is a reasonable assessment, especially if we understand that #3 can’t really happen, because unlike Medicare, which went into effect quickly, PPACA has a gradual rollout.

It will be most interesting to see what happens if the GOP gains power in the 2012 elections. Remember, it seemed obvious that President Obama would close down Guantanamo, but once he arrived in office he found it hard to do, even though not following through on his plans make him look bad.

There’s a similar challenge awaiting the GOP. Health care policy can’t just be ignored, but the main Republican ideas are unworkable, counterproductive or inconsequential. Repealing PPACA sounds easy, but something will be needed in its place. And having to seriously propose and actually pass that “something” won’t be easy, especially when traditional GOP constituencies such as corporations, health insurers and pharmaceutical companies make it clear that they don’t really mind PPACA and would rather just get on with it. And assuming the Congressional Budget Office continues to calculate that PPACA saves money, merely repealing PPACA adds to the deficit.


September 2, 2011

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