I am finishing up the syllabus for my Intro to the U.S. Health System course that I will teach this Fall at Duke University. This tutorial from www.kaiseredu.org on the role of Congress in health policy is excellent. The money quote from Sheila Burke (who has extensive legislative experience, including as Chief of Staff for Senator Bob Dole, R-KA):
Always remember that it is much easier to prevent something from happening than it is to enact a law
As she uttered this phrase, the following slide was on the screen
My take home from the tutorial is how hard it is to get things through Congress. First, this underscores how unlikely it was for the Affordable Care Act to actually pass and be signed into law. But, it happened. Second, it clarifies how hard it will be to even tweak the law, much less repeal it and then pass an alternative in its place. For example, the House of Representatives passed a repeal of the ACA, and submitted instructions to several committees to work on a replacement bill. The House Budget contained some ideas about how to reform Medicare (Rep. Ryan’s plans), but there have not been hearings on such a plan much less a committee mark-up. For all the noise about repeal and replace of the ACA, the House of Representatives has barely moved beyond the idea phase.
update: fixed a typo