For Obamacare, Assume Repeal Dead

After forty some-odd attempts to repeal the Affordable Care Act, some of which were sexier than others, it would seem that the GOP is slowly putting those days behind them. Yesterday, Sen. Ron Johnson (R-Wis.) essentially conceded that the repeal battles were over and that his colleagues needed to "start talking about transitioning."

And right before Thanksgiving, Rep. Jack Kingston (R-Ga.) -- one of several Republicans vying for the Senate seat of the retiring Saxby Chambliss -- put his electoral hopes on the line by insisting that letting the health care law fail would not be "the responsible thing to do." (One rival for that Senate seat, Rep. Paul Broun (R-Ga.), is already torching Kingston for it.)

While the Democrats who wavered in the face of Obamacare's rough-and-tumble November have commanded a lot of media attention, these Republicans who seem to be backing away from their party's all-in on Obamacaredämmerung wager are significant in their own right. There's a whiff of a notion, now, that the law may be a permanent fixture in American life (pending the result of one not-insignificant legal wrangling), and what's more, that it might even work (though it's probably too early to say anything definitive about that).

In a more immediate sense, however, the GOP has ended up boxed in as a result of its own tactical decisions, an "irony" that Avik Roy notes today over at Forbes:

President Obama's credibility has taken a significant hit since it became clear to the public that his signature promise -- that "if you like your plan, you can keep it" -- turned out to be dishonest. Polls now suggest that Republicans can retake the Senate in the 2014 mid-term elections. But the irony is that the GOP, having implicitly committed itself to protecting Americans' existing insurance arrangements, has backed itself into a corner. What happens in 2017 when tens of millions of Americans will be on Obamacare-sponsored insurance plans? Republicans have pledged to repeal the law, even if many of those Americans come to like their new health plans.

This is something that Philip Klein warned about in the Washington Examiner, writing that there was a "danger" in "making the idea that nobody’s coverage will ever change as a result of reform a tenet of Republican health care policy."

Of course, as I've pointed out before, the media didn't become interested in the whole "sad letter from an insurance company" phenomenon in time to help the nearly 44,000 people who lost insurance each week between January 2008 and December 2010. And it remains to be seen whether reporters will continue to enforce this exciting new standard for outrage. But repealing the Affordable Care Act opens the door for another round of headlines, and the discovery that the blade that nicked Obama is double-edged.

So what's the GOP to do, if not press for repeal? Well, it wasn't long ago that someone pointed out that "the gap between [the Affordable Care Act] and traditional Republican ideas is not very big" and there was ample opportunity to "align the plan more closely with conservative views." Those observations were made by David Frum, and they were probably part of the reason he's become an apostate among the conservative elite.

But if everyone assumes that Obamacare is now the semi-permanent structure in the health care market, there remain opportunities to work constructively within that structure and across party lines. Once laws are passed, things change: unintended consequences emerge, new problems loom and progress makes old worries obsolete.

There's no reason to believe there won't be room for new innovation -- and the potential for future fixes that come about through that spirit of bipartisanship that everyone seems to fetishize.

If nothing else, the bungled rollout of the HealthCare.gov website should be a distant early warning to lawmakers in both parties that we need some constructive reform in the Federal IT procurement system. The future of governing will involve more and more Americans turning to the Internet and their mobile devices for information and assistance, and it's in the interest of both parties to ensure that everyone has a seamless and positive interaction with the federal government.

Again, I don't want to get too far ahead of myself in predicting the permanence of the Affordable Care Act. Nevertheless, it seems to me that the future belongs to those who work within the structure of the law to make it more effective as health care evolves. This may come as bad news to those who have gone all-in on repealing the law, but things are what you make of them.

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Health Care Reform Efforts In U.S. History