House Republicans Repeal Health Reform. Now What?

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The House repeal of the Affordable Care Act, which passed Wednesday evening 245-189, isn’t the first time the landmark legislation has had the appearance of vulnerability. In fact, exactly one year before the repeal vote, Republican Scott Brown was elected to the U.S. Senate, filling the late Ted Kennedy’s seat and obliterating the Democratic super majority in that chamber. Brown’s victory over Massachusetts Attorney General Martha Coakley threw the health reform legislation, which had been methodically working its way through Congress, into jeopardy. In the Bay State on election night, our own Karen Tumulty wrote that in winning Kennedy’s seat, Brown was “potentially dealing a crippling blow to President Obama’s agenda,” including health reform.

Yet, then, as now, Democrats already had their next step safely sketched out. In 2010, they proceeded via reconciliation, the parliamentary maneuver that allowed Democrats to pass a final version of health reform with a mere simple majority in the Senate. (Typically, legislation must overcome a filibuster with 60 votes; Brown’s victory left the Democrats with just 59 Senators.) In 2011, Democrats will again rely on the rules of the Senate, specifically the rule that allows Democratic Majority Leader Harry Reid to set the agenda. It’s highly unlikely the House repeal legislation will be brought up for a vote in that chamber. Even if a Senate vote does take place, repeal is unlikely to pass. Even if does pass, however, President Obama will veto the measure.

The debate the preceded tonight’s repeal vote was mostly civil. As Alex noted earlier today, it was also familiar. Lawmakers from either side of the aisle talked past each other. There were the usual points and counterpoints – some honest, some not. Democrats cited Congressional Budget Office estimates that health reform reduces the deficit. Republicans cited their own estimates that said the opposite. There were lots of mentions of “government takeover of health care” and lots of stories about individual constituents who would suffer without health reform. There were some rhetorical flourishes, like Democratic Rep. Henry Waxman’s contention that repeal was like “Robin Hood in reverse.” *

But the debate was not exactly like the one that took place before the passage of health reform last year. Lots of freshman GOP members, many of them Tea Partiers, got their first chances to give speeches on the House floor. Several of them held up copies of the Constitution while they spoke. Trey Gowdy, a first-term member from South Carolina, said the Affordable Care Act amounted to “generational embezzlement.” Dennis Ross, a Florida freshman, implied that health reform would prohibit workers from taking insurance with them when they switched jobs. (Few Americans can do this, with or without reform.)

In addition, Republicans repeatedly explained that they were voting to repeal health care reform – futile as the effort was – because they told voters they would. “Repeal means keeping a promise,” said House Speaker John Boehner. Majority Leader Eric Cantor said, “We are here because we think it’s important to do in office what you said you were going to do.” Fair enough. Keeping a campaign promise is a good thing. But as all these Republican congressman talked about how voters rejected Obamacare in November and how they as members of Congress were elected specifically to repeal health reform, I couldn’t help but wonder: How many of those voters would have cast ballots the way they did if these same Republican congressman leveled with constituents last fall and told them that actual reversal of the law was basically impossible? Maybe everything would have turned out the same, but I can’t help thinking there is a good chunk of voters who actually believed their congressman could help overturn this landmark piece of legislation.

Another thing was different about this week’s health reform debate, compared to the one that took place in 2009 and 2010. This was post-Tucson. Rep. Debbie Wasserman-Schultz, a Florida Democrat and close friend of Gabrielle Giffords, evoked the fallen congresswoman in her debate remarks. Wasserman-Schultz said on the floor that Pat Maisch, the woman who grabbed the second round bullets Jared Loughner was planning to load into his gun, attended the Giffords meet and greet on January 8 to urge the congresswoman to vote against repeal. In addition, post-Tucson, there was a heightened sensitivity about inflammatory remarks. Democrat Steve Cohen, of Tennessee, compared Republicans to Nazi mastermind Joseph Goebbels, saying the GOP was lying just as the Nazis lied about the Jews. He stood by his comments in a later interview with CNN. Expect to see Democrats under pressure to condemn him in the aftermath.

As I wrote in the magazine last week, the war on the Affordable Care Act is just beginning. The repeal vote was step one, but it’s probably the least meaningful of all the steps Republicans will take to roll back the law. Next, they will try to chip away at the law by repealing individual provisions and withholding funding where they can. They will continue challenging the constitutionality of the law in federal court and they will resist the law within the states.

(*This post was update at 9:30 a.m. on January 20. A previous version contained a quote from Rep. George Miller that was incorrectly attributed to him.)