For the 33rd Time, House Votes to Repeal All or Part of the ACA

The House of Representatives voted today on repeal of the Affordable Care Act (ACA) – for the 33rd time!  No one was exactly on the edge of their seats awaiting the outcome, since the Republican majority voted on 32 previous occasions to repeal or defund all or part of the ACA.   (Some reporters have said today’s vote was the 31st, but I’m deferring to the Washington Post – which has a story today listing the previous 32.) 

The repeal bill was approved today by a vote of 244-185, with five Democrats voting with the Republicans.  (The first vote for repeal, in January 2011, was almost identical: 245-185.)

Some are calling today’s vote a colossal waste of time.  They argue that the House could have been doing something more productive, considering that the Senate wasn’t going to pass the bill, and the President certainly wouldn’t sign such a bill.   I understand that argument but I don’t fully agree, because the debate today might have been useful; unfortunately, I don’t think it was.I think it makes sense for Congress to have a vigorous and thorough debate about what the U.S. health care system should look like and how (or whether) it should be reformed. Health care reform will be a huge issue in the fall elections, and today’s House debate could and should have provided an opportunity to help voters understand where members of Congress stand on the issue. Unfortunately, today’s vote doesn’t seem to have revealed anything more than the previous 32 about what our Representatives think health care reform should look like.

Most opponents of the ACA have said it should be repealed and replaced. Yet even though the House has now voted on 33 repeal measures, we have yet to learn what the alternative is likely to be. 

Although we have little notion of what “replace” means, we do know what repeal would mean. WCCF’s recent top ten list summarized many of the current benefits of the ACA, and the following talking points from Families USA provide a very good synopsis of some of the popular aspects of the law that would be undone if the ACA is repealed:

• Repeal would take away protections against insurance company abuses such as: denying health coverage to people with pre-existing conditions (such as children with asthma or diabetes); withdrawing coverage when people get sick; setting arbitrary caps on insurance company payouts for people with major illnesses or accidents; and spending substantial portions of premium dollars on agents’ fees, marketing, advertising, administration, CEO compensation, and profits. 
• It would eliminate seniors’ abilities to get preventive care (like annual physician exams and screenings) for free and would take away the new help for seniors who need costly prescription medicines. 
• It would take away the requirement that insurance companies cover preventive care services like check-ups, mammograms, colonoscopies, and contraceptive services without any deductibles or co-payments, and would eliminate the prohibition that insurers can’t discriminate against women by charging higher premiums based solely on gender.  
• And repeal would eliminate the large tax credits in the new law that will help middle-class Americans purchase health care in 2014.

I suspect that some of the law’s opponents want to retain many of those parts of the ACA, but that’s still unclear. And it’s unclear whether they can agree among themselves on a revised package of reforms that could garner sufficient votes in either the House or the Senate.

By attacking the ACA as a whole, while avoiding offering an alternative, the law’s opponents can use it as a wedge issue. If they offered their own specific vision, we might see that there are many popular and important reforms that their legislation would not include, or perhaps we would learn that there are far more similarities than most of the opponents are willing to acknowledge.

In the months ahead, let’s demand that candidates tell us not just what they are opposed to, but what they will support. That’s our job as voters (on health care reform and a wide range of issues). Unless constituents and the press demand more specifics from candidates, we should expect that the political debate will continue to be about using wedge issues to gain political advantage, rather than looking for agreement, involving the public, and finding ways to make real progress.

Jon Peacock