This article first appeared in the St. Louis Beacon, Jan. 20, 2011 - WASHINGTON - Now that U.S. House Republicans have made a statement by voting Wednesday to repeal last year's health-care overhaul -- a repeal that seems headed toward a brick wall in the Democratic-majority Senate -- the real debate begins about which, if any, changes might realistically be made in the system.
The mostly party-line 245-189 vote in the Republican-controlled House now faces what many observers called insurmountable barriers in the Senate and the veto pen of President Barack Obama, who is dead set against repeal of what he regards as a landmark legislative achievement. In a statement this week, Obama said he would be willing "to work with both Democrats and Republicans to improve the Affordable Care Act," but he ruled out repeal because "we can't go backward."
Despite the barriers ahead, House Republican leaders directed six key House committees to hold hearings and develop alternate health-care legislation that might replace the existing law. House Republicans from the St. Louis region -- including Reps. Todd Akin, R-Town and Country, Jo Ann Emerson, R-Cape Girardeau and John Shimkus, R-Collinsville -- vowed to contribute to that effort.
"Today's vote sends an important message that we are focused on improving on an imperfect law," said Emerson. Akin told the Beacon that he wants Congress to develop "patient-centered health-care reform that addresses real problems in our health-care delivery system without creating new entitlements that will kill jobs" and increase government spending.
But the region's Democrats, all of whom voted against the repeal, urged the Senate to block the Republican repeal initiative -- and warned of dire consequences if the nation returned to the old health-care system. "It would have a huge negative impact on every American," Rep. William Lacy Clay, D-St. Louis, told the Beacon. "It would impose terrible human costs, and the damage would be long-lasting."
In his congressional district, Clay said, repealing the law would allow insurance companies to deny coverage for up to 258,000 individuals with pre-existing conditions, including as many as 35,000 children. He also said government figures indicate that repeal would eliminate health-care tax credits for up to 15,200 small businesses and 168,000 families and would "devastate seniors by increasing prescription drug costs for 8,900 Medicare Part D enrollees who have hit the 'doughnut hole.'"
Rep. Russ Carnahan, D-St. Louis, said in a House speech that the repeal "would hurt small businesses in Missouri who are finally gaining access to affordable coverage for their employees." Pointing out that health-care coverage has been increasing for small firms, Carnahan said repealing last year's health overhaul would mean than "small business owners will lose the tax credits that are providing up to 50 percent of their health care costs. Many of them will have to drop the very health insurance they have just now been able to afford to provide their employees and their families."
Repealing the health overhaul would return the nation to "the bad old days of insurance company control," Carnahan said. He warned that "insurers would be able to go back to denying coverage for pre-existing medical conditions, and small business owners would lose the tax credits that are helping make health coverage affordable."
But Akin and Emerson took issue with such assessments, arguing instead that last year's health-care overhaul has been harmful to many businesses. Akin contended that Obama's health overhaul was "fiscally unsound, infringed on the most basic liberties possessed by all Americans and imposed job-killing mandates and regulatory burdens on businesses."
He told the Beacon that "the discussion of health care will go forward" in Congress. Voting to repeal the health-care overhaul "is not to say that we are comfortable with where health care is," Akin said. While he described the nation's health-delivery system as the world's best, he said paying for that system "increasingly has become distorted and messed up. And that's the part we have to deal with."
From the House to the Senate
Bolstered by the repeal vote, House GOP leaders dared the Senate to take up the measure, pledging to battle the health-care law in other ways -- including targeted cuts in funding -- if the repeal fails to make it through the Senate.
"The American people deserve to see a vote in the Senate, and it ought not to be a place where legislation goes into a dead end," said House Majority Leader Eric Cantor, R-Va.
Many Republican senators agreed. Missouri's Sen. Roy Blunt issued a statement immediately after the House vote saying that he is "committed to examining all of the tools at our disposal to bring this fight to the Senate floor where the American people expect to see an up or down vote."
The Obama administration pulled out all the stops in the last couple of weeks to sway members of Congress and the general public in favor of the health law. This week, the Department of Health and Human Services estimated that 129 million Americans younger than 65 who have pre-existing health conditions -- including 2.6 million in Missouri and 5.6 million in Illinois -- might lose insurance coverage if the law is repealed.
Differing Views on Law's Impact
The Congressional Budget Office predicted that repealing the law would cost about $230 billion over the next decade. Emerson and Akin disputed that projection, saying that the current health-care law would, in reality, cost billions. And Republican leaders contended that the "job-killing" health law will -- if not repealed -- cost 1.6 million jobs, raise taxes, increase the deficit and add red tape to burdened businesses.
"Since the passage of ObamaCare, we have seen a huge jump in insurance premiums as companies anticipate the cost of the bill's mandates," Akin said in a statement. "Further, employers have announced benefit cuts and hiring freezes, as a result of the legislation ... When the full costs are considered, ObamaCare will likely cost taxpayers $2.6 trillion over 10 years, and the long-term impact is incalculable."
Clay scoffed at such estimates, which he said involve smoke-and-mirrors calculations.
"Far from being a job-killer, health-care reform is a job creator -- especially for regions like St. Louis where we have a major concentration of health-care providers," said Clay.
"Over the last 18 months, the economy has created 1.1 million private sector jobs; 20 percent of those jobs are in health care."
Rep. Jerry Costello, D-Belleville, said repealing the law would hurt thousands of people in his congressional district by allowing insurance companies "to deny coverage to 109,000 to 283,000 individuals, 2,700 uninsured young adults no longer able to stay on their parent's insurance plan, and 9,800 seniors who enter the Medicare Part D 'doughnut hole' having to return to paying 100 percent of the cost of their prescription drugs."
Adjustments and Alternatives
Costello said he opposed the Republicans' outright repeal of the health-care law because "we cannot afford to roll back critical protections for millions of Americans and increase the national deficit." But, he said, he expected that improvement and adjustments will be made to the law. "I fully expect that adjustments to the health-care reform law will have to be made as it is implemented, just as they have with Social Security and Medicare."
In the wake of the repeal vote, Emerson said her Appropriations Committee and other House panels are serious about developing alternates to the current health-care laws. "I know we can do better to control costs, to expand access in rural areas, to make it easier for small businesses to take care of their employees, and to get a better deal for taxpayers," she said. "Keeping in mind the parts of the bill everyone can agree are good and necessary, like guaranteed access to insurance for Americans with pre-existing conditions, we have a lot of work ahead of us to make our health-care system better."
Emerson argued that the law lacks honest accounting of the costs to taxpayers in the trillion-dollar bill, noting that the bill uses 10 years of revenue-raising measures to pay for six years of public health insurance exchanges. "We need to drive down the expenses of prescription drugs by negotiating the bulk purchase of medicines through the Medicare program and expanding discount programs to in-patient procedures. We need to have portability of health insurance products. And we have to get rid of IRS mandates on individuals and small businesses to carry or provide insurance and mountains of paperwork," she said.
Shimkus, a member of the Energy and Commerce Committee -- which will review aspects of the nation's health-care system -- said that he hoped "we can establish a new health-care law that removes annual and life-time caps on insurance policies, prevents restrictions such as pre-existing conditions from being used against a person, allows for the sale of health insurance across state lines, and makes high-risk pools more workable among other changes."
Freshmen Republicans who had campaigned in November on a "repeal ObamaCare" plank said Wednesday that they had delivered on their promise -- at least in the House.
"The American people have spoken and they don't want Washington bureaucrats coming between them and their doctors," said Rep. Billy Long, R-Springfield, who rode a wave of tea party support to victory last fall. "You can't make a silk purse out of a sow's ear but that's exactly what the majority tried to do last year by using 10 years of taxes to pay for six years of expenses."