A Pyrrhic Victory The outcome of last week’s vote on repeal was a foregone conclusion from the outset, but the victory was a hollow one. Almost no Democrats broke from their party to vote for repeal. While a few more signed on to the “replace” resolution, that was a very soft vote, putting them on record as willing to explore amendments without committing them to any specific alternative policy. At the same time, ACA supporters finally got a break on public opinion, if not exactly of the sort they were hoping for when the law passed. Although the public has yet to embrace the law overall, over the course of the debate, public opinion more or less solidified against a complete repeal, with multiple polls showing only a small percentage of the electorate supporting total repeal (roughly the same percentage believe Barack Obama is a Muslim).

The question is, what comes next? One likely candidate is an attempt to roll back the regulation requiring insurers to spend at least 80 percent of premium dollars on medical care (known as the Medical Loss Ratio or MLR). ACA opponents believe that they can make the case that the MLR regulation represents over intrusion of government into the business of insurance and that they will actually inhibit insurers ability to contain costs. However, most people are likely somewhat skeptical of both the ability and intentions of insurers as agents of cost containment and like the requirement that premium dollars get spent on medical care and the requirement that insurers pay rebates if their non-medical expenses are too high. Like total repeal, this should be an issue that plays to the advantage of supporters. Other issues in the pipeline relating to the Personal Responsibility Requirement and to Medicaid could prove to be more difficult challenges. (More on the threats to ACA implementation in a coming post.)

— Michael Miller, Policy Director