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Health care reform battle far from over

WASHINGTON — Americans should be prepared for two more years of verbal combat over health care reform when the new Congress is seated in January, but wholesale changes to the law are unlikely before the next election, experts say.

Republicans will gain a majority in the House of Representatives when the 112th Congress begins, having gained more than 60 seats, in part by stumping on a platform of repealing the new health care law. But without control of the Senate or the presidency, they most likely will be forced to fight by creating bad publicity for the law, experts say, keeping the issue on the national radar screen until a new round of voting, which they hope will get them enough seats to enact substantial change.

But at the moment, “the realistic chances for repeal are about as close to zero as you get in this world,” said Henry Aaron, a senior fellow in economics at the Brookings Institution.

“Keeping things at boil until the next election is pretty much in the cards,” he said. “There are a lot of folks who want to use every weapon they have to dynamite this thing.”

The Patient Protection and Affordable Care Act, signed into law in March, has been a divisive issue in the country ever since, making headlines and spurring votes in the midterm elections last month.

The act was designed to make health care more affordable so that all citizens can be covered, but many of its controversial details, such as mandatory plans by 2014, have drawn battle lines between supporters and opponents.

And although the divide is clear, exactly how a war of publicity will be fought, and who will win, remains uncertain.

“What (Republicans) can do is they can hold hearings on every bit of bad news (the law) generates for itself,” said Michael Cannon, the director of health policy studies at the Cato Institute. “The Republican House can hold investigations, they can grill them about this law, bring in the victims of this law. There are a lot of things that are unpopular.”

By doing so, Cannon said, Republicans create “tough votes or tough vetoes” for the Democrats when and if legislation to change, de-fund, or repeal the law is introduced.

Republicans also hope that more of the public will see for themselves the downfalls of the law as its provisions continue to roll out through 2014.

“The law was designed to front-load the benefits and back-load the costs,” said Lisa Wright, a spokeswoman for Rep. Roscoe Bartlett, R-Md. “So I would expect the law to become more unpopular going forward.”

“Democratic leaders refuse to learn the lesson that they won’t be the majority in the 112th Congress because they didn’t represent the will of the people when they rammed through the health care law,” Bartlett said in a statement.

Andy Harris, the representative-elect in Maryland’s 1st Congressional District and soon to be the state’s only other Republican in Congress, could not be reached for comment. His Democratic opponent, freshman Rep. Frank Kratovil, voted against the health care reform legislation and touted his independence in his campaign, but nonetheless was defeated in November.

Aside from repeal, Republicans are considering other legal options. A lawsuit was filed recently by 20 states and the National Federation of Independent Business. Representatives from those states — Maryland is not among them — argue the health care reform law is unconstitutional.

Trying to withdraw funding from the law is also an option, Wright said: “The Constitution gives Congress the power of the purse. House members will exercise rigorous oversight and seek to reduce the harm from the law by replacing and improving provisions.”

Any attempt to deny funds to the Department of Health and Human Services for implementation of the law will be vetoed, Cannon said. Republicans might attempt it, however, just to build more tension and, in turn, more support for repeal, he said.

While Republicans remain hopeful Americans will grow more frustrated with the law, many Democrats are expecting is the opposite — that as its provisions are rolled out, those affected will be pleased with the results and support the law.

“The two most important things we did were expanding universal access and ending the punitive practices of insurance companies, particularly around pre-existing conditions. When people find that out, they don’t want it taken away,” Sen. Barbara Mikulski, D-Md., said in a written statement.

Even Democrats aren’t opposed to the idea of tweaking the law, however.

“There might be some fixes that the president would agree to,” said Lawrence Gostin, the faculty director of the O’Neill Institute for National and Global Health Law at Georgetown University.

Mikulski agrees.

“The health care reform bill isn’t perfect, but it’s a great start,” she said. “I would still like to look at how we can reduce the hassle for doctors and how we can bring in more quality standards for better care. But we’ve seen some great progress already.”

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