While many on the right are gearing up for a “Repeal the Bill” campaign, and Michele Bachmann has even provided the one-page repeal bill, the reality is that the reform bill passed yesterday has changed the landscape irrevocably: Republicans simply cannot repeal the bill until 2012, and even then they would probably need both the presidency and a filibuster-proof majority. Who knows what the political dynamics will look like by then?
As Phil has suggested, though, many of the most important health care debates are just beginning. Although Obamacare is billed as comprehensive, a lot of policy remains effectively up in the air, as critical aspects of the bill will change even before official implementation. This reality is partly a consequence of the long lags before important measures come online and partly a consequence of the steps the Democrats had to take to woo key players and navigate the legislative process. For example, as Phil suggests, the left will continue to try to introduce a single-payer system, within the new framework of Obamacare.
The Tax Policy Center’s Howard Gleckman highlights two other major provisions of Obamacare that are likely to undergo significant changes before they ever come into effect: the Medicare tax and the Cadillac tax on gilded health care plans. Gleckman writes,
I have never quite seen a law so full of powerful tax bombs attached to delayed fuses. The two biggest: A stiff new Medicare tax on high-earners that does not bite until 2013 and a tax on high-cost health insurance that does not kick in until 2018 — long after the end of an Obama second term, if he has one.
Both taxes, Gleckman explains, are not adequately indexed for inflation and will eventually affect more workers than promised in the bill. And both, he doesn’t mention, were significantly shaped according to legislative needs rather than policy recommendations. The Cadillac tax, for instance, was delayed until 2018 to buy off unions protective of their hard-won generous benefits. The Medicare tax is designed to fall on wealthier taxpayers so as to avoid the treacherous political strategy of taxing the middle class. But unions don’t want to pay the Cadillac tax — not now, and not in 2018, so they’ll be pushing to repeal/change that measure starting today. And the increase in the Medicare tax will be politically troubling once high earners start seeing the major increases in their payroll taxes. Gleckman concludes, “In the end, I’m betting that nobody will pay these taxes in quite the way the new law requires. It will be fun, however, to see how they change.”
But these are two major funding sources for the health care overhaul that are set to face significant changes — the bill was designed to “repeal” parts of itself. Critical features of health care reform are still up in the air, and the right could easily help determine how they shake out.