Observers watching the Senate on the afternoon of March 13 could be forgiven for feeling a little bit of déjà vu. Senators were once again voting on a motion to try to disable the 2010 health care overhaul — this time by delaying any funding for the law, courtesy of an amendment from Republican freshman Ted Cruz of Texas.
As they have done before, Senate Democrats beat back the effort, and the amendment fell, 45-52, on a party-line vote.
Nine days later, they did it again. During votes on the Senate budget resolution (S Con Res 8), Cruz offered an amendment to provide for the repeal of the law, which the Senate defeated, 45-54.
Since President Barack Obama signed the bill into law in March 2010, lawmakers have voted more than 30 times on measures to repeal or defund all or part of the health care overhaul. Also during that time, the Supreme Court largely upheld the law as constitutional, and Obama won re-election over an opponent who said he would begin to repeal the law on the first day of his presidency. Despite these setbacks, congressional Republicans have continued to beat the “repeal” drum.
In the past three years, polls have shown a slow but perceptible movement among the public toward acceptance of the law. And as deficit concerns and economic woes took center stage, the health care law became a less important issue among the overall public.
But pollsters and GOP lawmakers say Republicans can keep pushing for full repeal without big consequences. New members want to make sure their constituents know where they stand, and conservative groups want to make sure other members aren’t weakening their stance. And perhaps the biggest reason to keep fighting for repeal is that Republican voters back home remain dead-set against the overhaul they deride as “Obamacare.”
“Republicans have absolutely nothing to lose by continuing to raise the issue,” says Robert J. Blendon, a health policy professor at the Harvard School of Public Health who directs the Harvard Opinion Research Program. “Republicans don’t like this bill. They have not changed. So if I am a Republican and I’m a House member, particularly that comes from a district that’s mostly Republican, there is no downside for me being against this bill.”
Base vs. Base
Public support for the law appears to be inching up. In a CNN/ORC poll from January, 51 percent of respondents said they favor all or most of the law, compared with 45 percent who said the same in January 2011. A CBS News/New York Times poll from January found that 42 percent of respondents wanted to expand the law or keep it as is. Last July, 32 percent of people chose those options.
There remains, though, a strong partisan divide when it comes to the law. In a January survey by the Kaiser Family Foundation, the Robert Wood Johnson Foundation and the Harvard School of Public Health, a small majority (52 percent) of total respondents said the law’s opponents should continue to try to change or stop it. But 67 percent of Democrats surveyed said they wanted to see opponents cease their efforts, while 78 percent of Republicans said the law’s opponents should continue. Among independents, 59 percent said lawmakers should endeavor to stop or change the law.
That shows that Republicans are satisfying their base voters by continuing to push against the law, Blendon says.
“For their own base and people who lean towards them, it’s not costly to be against this bill at the moment,” he said.
That helps explain why Cruz pushed his amendment in the Senate and the Republican-led House adopted a fiscal 2014 budget resolution (H Con Res 25) that would repeal most of the law.
For their part, Democrats say the continued push for repeal is repetitive and pointless.
“There are still some in Congress who stubbornly refuse to accept reality,” Sen. Tom Harkin, D-Iowa, said in a written statement last week. “The old battles have been fought, and the American people have spoken. It is time to move forward — not to be dragged backward — to create a reformed health care system that works not just for the healthy and wealthy, but for all Americans.”
For the Record
Another reason for the continued repeal votes is that newcomers to Congress want to get on record as opposing the law — especially those who ran campaigns based on repealing it.
“Some of the newer, newly elected members in the Senate had not been asked to cast that vote,” Sen. John Barrasso, R-Wyo., said of the move to adopt the Cruz amendment. “Now we have on record all the members of the United States Senate, current members of the United States Senate, on that, so I think there is value in doing that.”
Sen. Mike Lee, R-Utah, who co-sponsored Cruz’s amendment, agreed that it was important to get lawmakers on the record one more time.
“The naysayers, those who say we don’t need to have this vote because we know how it’s going to come out, ignore the fact that this is an important part of the process — an important part of the process whereby voters across America can hold their elected representatives accountable to see who still supports the implementation of this law,” Lee said.
Many Republicans also are wary of facing a potential primary challenge from opponents who paint themselves as more conservative. Voting to repeal the law is one way to prove conservative bona fides. The Club for Growth and FreedomWorks both counted the vote on the Cruz amendment as a key vote.
“Senior Republicans who are up in the Senate still face challenges, and the challenges come from the right and not from the left,” Blendon said.
Repeal Before Replace
The second half of the Republicans’ goal to “repeal and replace” the law can get overlooked with all of the repeal votes. But some observers say the health care law must be swept out first before the GOP can start replacing it with its own health care policies.
“What’s being done here is to clear the way for other things Republicans want to do in terms of reforming the health care system,” said David Winston, president of the Winston Group, a strategy and polling firm.
He mentioned GOP standbys such as allowing people to buy insurance across state lines, changing the medical liability system and turning Medicaid into a block grant system, which was proposed in the House GOP budget blueprint.
Winston said promoting these policies, along with working to repeal the law, is an important part of Republicans’ outreach to voters.
“There’s an increasing frustration that it’s just not working,” Winston said of the voters’ views of the law. “They’re looking for something better, and it’s incumbent upon Republicans to provide it.”
Some Republicans think the law will collapse under its own weight — and they hope their measures to repeal individual parts of the overhaul will speed that failure along. Republicans have introduced legislation to repeal a tax on health insurance plans, eliminate restrictions on health savings accounts and flexible spending accounts, and strike out the board that is tasked with finding ways to reduce Medicare spending growth.
So far, Republicans have had some success with individual repeal measures, notably in reducing funding for the law’s implementation and repealing a tax-reporting requirement for businesses. And at least one other repeal bill could be headed for success. During the Senate budget votes, lawmakers adopted an amendment, 79-20, to repeal a 2.3 percent excise tax on medical devices that took effect in January.
Those victories raise a question for the GOP: Is it better to push for full repeal, or are time and effort better spent striking down the most reviled parts of the law?
Many lawmakers seem to be trying to do both. At a press conference touting several bills that would eliminate important parts of the law, including the requirement that individuals buy insurance or pay a penalty, three GOP senators emphasized that they still wanted full repeal.
“I prefer to take down the entire law,” Barrasso said at the event. “Otherwise, we’re going to go after it piece by piece.”
Republicans realize that full repeal is still a long way away, and chances are slim as long as Democrats control part of the government. One longtime opponent of the law spoke to the frustration he has felt since Congress began work on the law in 2009.
“If you’ve listened to me over the years, I said it’d never pass in our committee. Well, I was wrong,” said Rep. Michael C. Burgess, R-Texas. “I said it’d never pass on the floor — I was wrong.
“I said, ‘They’ll never come with a compromise from the Senate,’ and I was wrong.
“I said, ‘The president will never sign it.’ He did.
“I said, ‘You just wait, the Supreme Court, they’re gonna nix it. They’ll pull the rug up from under it.’ I was wrong.
“And then I said, ‘Well, the American people are going to rise up as one and spike this thing in the election, and then we won’t have to worry about it anymore,’ and I was wrong.”