Starving the ACA to death

Pivoting off the Politico story on how Republicans plan to “choke” health care reform to death, Autsin Frakt has a post up which reiterates his concern that politicians opposed to the ACA could, in effect, starve it:

Make no mistake, repeal by purse strings could create a mess. The law has many moving parts that act together to create a sensible, complete whole. And implementing a piece of legislation as complex as the ACA requires fully funding the agencies that oversee it. So, this strikes me as the most politically viable, serious attack on health reform.

I’ve thought as much for a while. Back in December 2009 I wrote,

To the extent we hear more about health reform it will be for one reason: the money. While the legislation may be internally balanced so it scores as deficit reducing, it will not be viewed as monolithic once it passes. It has both spending and savings. Could we keep the savings and gut the spending? Sure.

Who would do that, and why? Answers: Republicans, for tax cuts. While the former are out of power, that won’t last forever. And the latter are always popular. This reform will be attacked. Things may quiet down, but this is not the end of it. Money has a way of drawing attention and a crowd.

The combination of “savings” created by failing to fund implementation and tax cuts is likely to appeal to the Republican base. Keep in mind that the ACA does very little for the broad middle-class of voters who are covered in the large-group market. In these hard economic times, such voters may prefer some money in their pockets than additional spending on a program for which they expect little benefit. (Of course losing one’s job jeopardizes one’s insurance so the ACA really does add a meaningful layer of protection for all Americans.)

As I said before, I don’t think this is very likely.  It”s the popular things that cost money. Closing the donut hole. Subsidies. Decreased Medicare copays. The “bad” stuff like the mandate can’t be easily defunded. So when they actually go to starve things, it won’t be nearly as popular as they think.

Moreover, I think that think this is exactly the fight the White House wants. Up until now, Republicans could only make threats. To actually defund it, they would have to put something down on paper. They will be attacked ruthlessly for it. And it still likely won’t pass.

I bet they don’t do it.

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