Profiles in Plausibility: The Politics of Health Reform Rollback

I still agree with Matt Yglesias and Aaron Carroll, both of whom find the my scenario of a Republican rollback of health reform provisions unlikely, even if it is more likely than repeal. The key to its implausibility is the 60 votes it would take in the Senate. That’s the nature of filibuster politics. As long as that’s still the game, I think health reform is safe. (Of course one can contemplate budget reconciliation and changes to the filibuster rules…Let’s not go there now.)

But that doesn’t mean the threat of rollback isn’t important. It is. As I wrote before, perhaps the biggest political risk of health reform’s passage is not to the statue but to the party that backed it. Republicans may not be able to repeal or rollback anything, but they can gain seats campaigning as if they can and will. Their plausible pitch, which I outlined in my prior post, is to the middle class. Wouldn’t it be better for the middle class, Republicans might argue, if they had access to cheaper insurance (never mind it would cover less) along with some tax cuts paid for by allowing the low-income subsidies to gradually erode in real terms?

In fact, as a campaign tactic, one doesn’t even need to explain how to pay for the tax cuts. A simple message of the type, “This reform doesn’t do much for the middle class. Obama and the Democrats are taking your money to pay for a new wasteful entitlement. Wouldn’t you like it back?”

On the campaign trail it may not even matter if this makes any sense. Although, the fact that it doesn’t is exactly how liberals and progressives should attack it. If health reform is debated at all, this is how I expect the debate might go.

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