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Among the more grandiose claims repeatedly being pledged along the Republican presidential campaign trail is that each of the hopefuls would repeal the Patient Protection and Affordable Care Act (ACA) – but does a president even have that power?
Newt Gingrich and Mitt Romney, for instance, have mentioned signing an Executive Order on day one, should either be elected. Such a document, however, is merely the beginning of a lengthy process. Ron Paul, a former air force surgeon, has a long list of how he would improve America’s healthcare system, including expanding health savings accounts and adding some tax breaks. And Rick Santorum promises to institute patient-centered healthcare after repealing the ACA.
Repeal. That’s the big healthcare promise candidates are vowing to prospective voters but, in reality, it simply cannot be accomplished in one day, if it can be delivered in its entirety at all.
Only Congress can repeal the ACA
Joseph Antos (pictured at left), an analyst for the American Enterprise Institute for Public Policy Research is skeptical on presidential election healthcare promises, at best. “Politicians operate on the concept that anything they promise, they don’t have to keep,” he says.
[Commentary: The blindness and brilliance of Obama’s individual mandate.]
Antos is not naïve to Washington and healthcare. In addition to conducting research on the economics of health policy for AEI, he is a commissioner of the Maryland Health Services Cost Review Commission and a health adviser to the Congressional Budget Office.
“On the Republican side, all candidates say words that seem to mean repeal, but of course, the president alone can’t repeal anything,” Antos explains. “A repeal of a federal law requires Congress’ complicity. If Republicans manage to keep a majority in the House, they are not so likely to a get majority in the Senate, and they won’t have 60 votes to overcome filibusters. The bottom line is, if the Republicans take the White House, they could certainly start the ball rolling [on repeal], but it’s really up to Congress to take that action.”
Antos also points out that there are many things in the healthcare landscape that will change by next January. For starters, the Supreme Court hearing slated for late March may give some kind of resolution to an incredibly divided nation on the topic, or it may muddy the waters further.
Beyond that, a new Republican president’s constituents may like some of the privileges they have gained through ACA, and may even want to retain some of them, which would no doubt make it politically difficult to get the law repealed.
Antos offers a case in point. Most of the ACA won’t take effect until 2014, but some provisions have been instituted already. One of those is the right for children up to age 26 to remain on their parents’ healthcare plans. In all fairness, Antos says, this particular provision is not at the heart of opponents’ concerns. But, “what it illustrates, is how difficult things are to repeal,” Antos continues. “Once you start looking at it more carefully – what can you take out, what reacts with what — it gets to be very complicated. You can’t remove provisions without putting something in their place.”
Republicans campaigning on ACA repeal would need an alternative, and no one has shared much in the way of intentions regarding how they would proceed.
“It’s one thing for the candidates to have a plan of action,” Antos adds. “It’s a complicated process to make that happen.”
[Political Malpractice: Will health IT bipartisanship survive the elections?]
Romney has said if he is elected, he will issue state waivers to eliminate the ACA. Antos reminds that a state must ask for a waiver. No president can force a state to waive a current law. There will be some states, like Texas, that would like to waive everything about ACA. Other states, like New York, Massachusetts and California are unlikely to even apply for a waiver, if it would mean the state gets less federal money. Eleven states, in fact, have publicly banded together to ask the Supreme Court Justices to uphold the law.
Republicans might have more luck trying to block certain aspects of ACA by keeping the Department of Health and Human Services from meeting deadlines. If that happens, it’s possible many things will go by the wayside.