Our Health Care Future: America's Political Football

On July 30, the Bipartisan Policy Center (BPC) hosted a group of experts to address the impact of the U.S. Supreme Court ruling on the Patient Protection and Affordable Care Act (PPACA). The keynote speakers and roundtable discussions focused on the future of the Medicaid program, insurance market reforms and the political consequences of the decision. The second in a series, this blog post summarizes the forum’s political consequences discussion.

Background

By now, it is no surprise to anyone that the two political parties differ on health policy. Indeed, Democrat and Republican differences are reflected in the deep divide in public opinion over the law. Leading up to June 28, 2012, both sides expected the Supreme Court to reaffirm their positions and boost their standings heading into the November elections. July’s KFF tracking poll indicates that public opinion shifted very slightly after the decision – 44 percent of Americans have an unfavorable view of PPACA and 38 percent support it (a one percent bump in support over pre-decision polling). In the near term, the Court’s decision upholding PPACA’s constitutionality is a victory for the Obama Administration; however, the long-term political consequences of the decision are unclear.

Panelists on Politics

At BPC’s health care forum, an expert panel featuring Chris Jennings, President of Jennings Policy Strategies, Co-Director of BPC’s Health Project, and an Obama presidential campaign advisor; Sheila Burke, Senior Public Policy Advisor at Baker, Donelson, Bearman, Caldwell & Berkowitz, PC, and Co-Director of BPC’s Health Project; and Thomas Scully, General Partner at Welsh Carson, Anderson and Stowe, Senior Counsel at Alston & Bird, LLP, and a Romney campaign designee, examined the broader political implications of the SCOTUS ruling. Ceci Connolly, Managing Director at the Health Research Institute of PricewaterhouseCoopers, moderated the panel.

The panel considered the varying impacts the Supreme Court (SCOTUS) ruling and PPACA might have on future health care politics, the 2012 elections, and how we think about the role of government. Some highlights from the discussion are below:

Impact on Voters:

• Jennings described how after two years of arguing and an additional two years litigating over health reform, the American public has reached a point of health care fatigue. He assessed that “the political impact for independents – the most important voting group in this election, is that they find the ruling largely as an affirmation of the law, and really want to move on to other issues like the economy and jobs.”
• Burke agreed with Jennings that PPACA would not play a central role in the 2012 elections, stating “health care is rarely the single vote on which people make a decision. Depending on the constituency, it can have an influence, but is rarely the most important issue.”
• Scully saw the issue differently. While not disputing the importance of the economy, he contended that the Supreme Court ruling was a winner for President Obama on June 28, but ultimately would be a net-loser for him on Election Day.

Role of Government:

• To the extent voters do focus on health care in the 2012 election, Burke articulated that “the issue may well be in this context the question and role of government, and how [voters] perceive the decision with respect to health care in terms of how to position that role of government.”
• Following Burke, Scully claimed the SCOTUS decision locked in an image of the current administration pushing too much big government. Scully noted that “the impact is the perception that the health care bill gives that we’re taking on a massive entitlement expansion, and a massive growth of federal government, when we already have a 9 percent of GDP deficit even before we take on any of this stuff.”
• In response, Jennings asserted that the public supports neither big nor small government, but instead workable and responsive government. Jennings suggested that whichever party better defines their policy positions in line with this view of competent government stands to gain in the upcoming elections.

State Politics of Medicaid:

• While conventional wisdom deems the SCOTUS outcome on the Medicaid expansion a loss for PPACA, Jennings hypothesized that giving the states a choice on the expansion might actually be a win in the long-term. He elaborated that states “have to take the option to expand or not to expand, and to the extent they make that choice they will be far more invested in that. From a political perspective, that’s better for the sustainability of the law.”
• Burke echoed Jennings’ sentiment, expressing that states would like to have greater flexibility.
• In response to questions about why Governors might turn down the almost entirely federally-financed Medicaid expansion, Scully explained, “when you ask a Governor how can you turn down 100 percent free federal money, the answer in a conservative southern state if you are Rick Scott or Rick Perry is, ‘this is taxpayer money, we don’t care if it’s federal or state… This is not free money.’”
• In response, Connolly clarified that “even if Governor Perry and Governor Scott say their states will not do the expansion, it will not save their constituents the tax cost of paying for it.” All states must pay taxes into the Medicaid expansion, even if they do not utilize it.

Stakeholder Interests:

• According to Jennings, “the most interesting part of the PPACA was the broad stakeholder support for the legislation. You had pharmaceuticals, hospitals, labor, consumer, AARP, AMA, AHA, etc… You had everyone except for the partisan debate… They did so because they wanted to find a sustainable way to make the market work.”
• Scully disagreed with Jennings’ rationale, contending instead that it was only natural for health stakeholders to support PPACA because it was a major expansion of health care likely to earn them more money. Scully continued, “Why are all the stakeholders, the hospitals, insurance plans, and drug companies for the PPACA? Guess what – they all got a lot more money! That’s why they are for it. Now look at the nursing homes and the health agencies, they are not so much for it, why? Because they took cuts and didn’t get much out of it. Where you sit is where you stand.”

Future Dialogue:

• Connolly highlighted how the two political parties’ stances on health care differ almost to the extent of Venus and Mars, and inquired how we might find common ground moving forward given such a polarized environment.
• Jennings admitted he did not see a clear path forward, articulating that “in a perfect world, the parties would work together and collaborate, but I think we are in two different polar opposites, almost solar systems… it’s hard to even conceive of that conversation taking place.”
• Burke challenged policymakers to work to find as much positive, common ground as possible amidst this tough political climate — similar, she suggested, to what a Bob Dole administration might have done for health reform.
• Pushing back against Scully’s comments predicting the future repeal of PPACA, Jennings reasoned that “over time as the law gets in place and is implemented, people become used to the law and become very dependent, making it very hard to repeal from a political and policy perspective.”

In wrapping up the wide-ranging political debate, Connolly asked each panelist to name one positive thing happening in health today. Jennings quipped, “the successful implementation of Romneycare.” Burke followed by highlighting recent extraordinary advances in health care delivery, emphasizing how “we can take care of people now who 10-15 years ago would’ve died.” Finally, Scully recognized increasing market competition as a force for good in health care. While much has been accomplished, it remains to be seen how the conflicting political forces might find reconciliation to tackle the big challenges ahead.

View full event information and videos available here.