Actually, its greatest point of vulnerability will be the 2012 election, since much of it doesn't take effect until 2013. The mandates that will drive up costs will take effect before then--young people will pay much more since premiums will be equalized for all age groups and private companies will have to cover even sick people. Since there will be no opt-out or no competition, they will be able to charge whatever they want.]]> By 2012, the exchanges that will get small business owners and employees insured are not supposed to be set up. So basically, all the politically and economically costly things go into effect first, and the beneficial things (insuring people and taking burdens off small business) will not have materialized. It's perfect for demonization.
I'm sorry, but the 2012 campaign is going to be all about repealing health care reform, and it will find a sympathetic audience if the schedule isn't fixed.
This is actually a point I've given a lot of thought to. And it's an important and complicated point. It's true that key parts of the legislation don't go into effect until 2013, or at least that's where things stand right now. It less clear to me that a hypothetical unified Republican government in 2013 would be able to repeal the law just as the most beneficial parts of the legislation are coming into effect.
But it does make me wonder why the schedule can't be tweaked at least a little. Certainly changes as big as these can't happen over night. But you could see where early 2012 as opposed to 2013 could make a pretty big difference.
Late Update: I realize that the original version of this post wasn't entirely clear. It was not my understanding that mandates and the exchanges are staggered in the way that BK suggests. And I've just confirmed that that is not the case. The issue is that few of the structural changes go into effect before the 2012 election. Bans on denial of coverage for pre-existing conditions, dropping people as soon as they get sick ("recision") will go into effect earlier, basically new regs cracking down insurance companies' behavior. And those should be popular for a lot of people. But the stuff that really tackles cost and other aspects of availability won't go into effect during this presidential term. That's problematic politically for the Democrats. And I think it also raises the real prospect that the insurance companies will start pulling various pricing shenanigans in advance of 2013, hoping they can create the political climate for repeal before those parts of the legislation come into effect.
]]>The reason these sorts of events happen so infrequently is that they are like colossal ships or vast armies, very difficult to build or assemble and get on their way but also extremely difficult to stop or turn once they are under way.
As Bill Kristol noted in his famous 1993 GOP strategy memo on the Clinton health care reform initiative, the key danger Republicans face from health care reform is precisely that the public will like it. And I suspect that the more forward thinking and perspicacious of his partisan colleagues today see it the same way.
If a health care reform bill passes, it's greatest point of vulnerability will be in the 2010 election. That's not only because of the on-going fall-out of the 2008 financial crisis, which sets the Democrats up for a tough midterm election. It's also because a lot of the key reforms in the legislation don't kick in for a few years. But even if you assume the worst possible outcome for the Democrats in 2010, loss of both houses of Congress, Republican majorities still wouldn't be able to overturn the law because President Obama would veto their repeal.
Last night's vote makes me think this will happen and it will be a genuinely historic development.
]]>One Republican voted for the Democratic bill: Rep. Anh "Joseph" Cao (R-LA). See this post from earlier this evening on the background to his vote. Here's Cao's statement on his vote.
Late Update: Here's the roll call on the final vote. And for those keeping score at home here's the roll call on the Stupak abortion amendment.
]]>Late Update: We have one GOP vote for -- presumably that's Rep. Cao (R-LA), though no confirmation on that yet.
The final vote appears to be 220 - 215.
]]>11:01 PM: Not too much to talk about on a final vote live blog. Currently at 196 for, 29 Dems voting against.
11:03 PM: Currently ten more votes needed and 14 Dems still to vote. Presumably they're going to do this on a straight 218, just like in the Clinton years. No 'wasted' votes.
]]>Late Update: Rep. Tim Johnson (R-IL) was the sole Republican to vote against the Boehner bill. No one seem really clear as to what his reasoning was. As I noted below, Rep. Cao (R-LA) is the only member of the Republican caucus believed to be in play. And he voted for it, though in a high stakes case like this it would not be surprising to see him vote for both.
]]>I wonder if Michele Bachmann wearing a lei (on the Floor) means she has recognized that Hawaii is a state and President Obama is a citizen?]]>
But also remember Cao's political position.
]]> He was elected in 2008 in an overwhelmingly Democratic and African-American district in New Orleans. And the only reason he was able to do so is that he was running against Rep. Bill Jefferson (D-LA), who at that point was under indictment but not yet convicted of various public corruption charges, the most well-known of which was tied to that notorious $90k found in his freezer. To understand Jefferson's political position at that point, remember that the crux of the accusations against him first surfaced in 2005. So despite his popularity and strong political base at that outset, his constituents had had three years to absorb the seemingly overwhelmingly evidence of his corrupt acts.Cao's ability to hold that seat against a non-indicted Democrat seems highly questionable. It went 75% for Obama. And the White House has been in close touch with him through the day. An aide tells Roll Call, "Rahm is going all in to get him."
Those would be some interesting conversations to listen to.
]]>Late Update: I went back watched the video in question several times. And though Tancredo said "you bet" to the "appropriate" question, it seems to me that he got confused in the cross-talk between him and the interviewer David Shuster. In context, I think Tancredo meant to say it was inappropriate, in other words, the opposite. The perils of live smash-mouth television. Don't worry. Tancredo said lots of other crazy stuff. But I don't think he meant to say this was okay.
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