If Republicans take control of the Senate next year, which seems highly plausible right now, they will surely intensify their war on Obamacare. Last week Bloomberg Government issued an analysis (subscription required) on the prospects for the law in 2015, including how the administration might respond to attacks from a Congress under full Republican control.
BGOV's conclusion? The administration would cut spending on technology for healthcare.gov and insurance exchanges while relying on a "new source of funds: user fees, authorized by the health law, that are paid to exchanges by insurers that sell policies through them."
With Republicans running both sides of Congress, Obamacare would receive no discretionary funding. Indeed, funding for key aspects of the law's implementation has already been spent down or restricted by congressional action.
That's not fatal. The law's mandatory funding -- mostly Medicaid expansion and tax credits to help consumers buy insurance on the exchanges -- can't be stripped out by a hostile Congress. In addition, the user fees cited by BGOV, which will be paid by insurance companies to the health care exchanges, will probably yield at least hundreds of millions of dollars. And Barack Obama presumably will rely on one more thing: a new constituency of millions of Americans who are insured through Obamacare and won't want to lose their subsidized health care.
That sounds like enough to keep the law rolling forward into enemy fire, albeit less than smoothly.
As Sarah Binder of the Brookings Institution points out via e-mail, a Republican Senate majority would be the result of conservative Democrats losing elections in red states. The remaining Democratic caucus would be more liberal than the current one and probably even less inclined to accommodate attacks on the law. Consequently, Republicans would face stiff resistance in the Senate, including filibusters.
In the White House, Republicans would face a president in his final two years of office, with no more campaigns to win and a powerful interest in protecting the legislation most likely to define his legacy. It is difficult to imagine any circumstance -- including an extended government shutdown over funding -- that could induce Obama to damage Obamacare intentionally.
That's not to suggest Republicans won't try. "Congress could try to enact appropriations bills that do not fund those entitlement benefits," said Richard Kogan, a senior fellow at the liberal Center on Budget and Policy Priorities, via e-mail. "I cannot imagine that the president would sign appropriations bills that deliberately fail to fund existing entitlement law, or deliberately fail to fund administrative costs necessary to implement entitlement law. Likewise he would not sign an appropriations bill containing riders that directly or indirectly repeal the program."
It's not clear Republicans could even sustain such a threat. "In 2015, if Republicans win the Senate and retain the House, some minor changes might be offered," said Steve Bell, a former Republican staff director of the Senate Budget Committee who is now senior director of economic policy at the Bipartisan Policy Center. "But once such a constrained bill reaches the Senate floor, all bets are off and things may well collapse."
In other words, the Republican penchant for overreach would make even modest retrenchment of Obamacare an uncertain proposition. As Paul Waldman noted on the Washington Post's Plum Line blog, House Republicans, who have never quite registered the limits of divided government, may simply keep voting for full repeal. That would probably force Senate Republicans to do likewise, leading to a series of legislative dead ends.
In a similar vein, Republicans' ability to offer a realistic alternative to Obamacare remains doubtful. Health insurance is expensive. If you cut the subsidies, you cut the number of people insured. And Republicans continue to oppose both the subsidies and the taxes that make them possible. With Obamacare in place, any Republican proposal is virtually certain to increase the number of Americans without health insurance, limiting its appeal.
At the same time, Republicans will face enormous pressure from conservative voters, who have been told by Republican leaders for years that any day now they shall be released from the "atrocity" of subsidized health care. Senate Republicans have made routine use of the filibuster during the Obama era. If they do take control of the Senate, they may view Democratic filibusters on health policy as less a hindrance than a favor -- providing a new excuse for why Obamacare is still the law of the land.
This column does not necessarily reflect the opinion of Bloomberg View's editorial board or Bloomberg LP, its owners and investors.
(Francis Wilkinson is a member of the Bloomberg View editorial board. Follow him on Twitter.)
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