Well, that didn’t take long. Having delayed their long-promised vote to repeal health care reform by a week (out of respect for victims and survivors of the Tucson shooting), the House of Representatives passed their bill after two short days of debate. House Majority Leader Eric Cantor asserted that the health care reform legislation had not fulfilled its stated goals of cost containment and insuring everyone, and “it won’t even go into effect until 2014,” so the fiscally responsible thing to do was to stop the construction of the law’s complex system. Meanwhile,  those who’d devised the Affordable Care Act argued that the system, once complete, will reduce the deficit compared to the alternative, and the dangerous thing is to prevent this change from occurring.

The debate was brief and not very explanatory, and the vote’s outcome predictable, given the number of House freshmen (left)  elected partly on a promise to “repeal and replace” the plan they call “Obamacare.” But the debate that took place in the media and before the formal House debate enabled both sides to examine the issue anew, and for Americans to perhaps become more familiar with some provisions already in effect.

In preparation, the White House rolled out endorsements such as: “The American Medical Association does not support initiatives to repeal the Affordable Care Act. Expanding health coverage, insurance market reforms, administrative simplifications and initiatives to promote wellness and prevention reflect AMA priorities.” It also issued videos like the one below, with personal stories of some of its beneficiaries. HHS Secretary Kathleen Sebelius hit Capitol Hill  to issue sober reminders of the situation the ACA was created to address — like the 129 million Americans under 65 with pre-existing conditions, who are vulnerable to being denied private insurance with job loss.

No one, even in the truncated debate, is saying that the status quo is sustainable or the plan’s goals unworthy. Neither Cantor or Speaker Boehner “ever bothered to engage with the fundamental moral logic behind the Affordable Care Act,” writes Jon Cohn at The New Republic, “never questioning  that a modern society guarantees everybody access to doctors, hospitals, and the treatments they provide [and]  that it’s wrong to sit by and watch people give up their savings, or their lives, just because they happened to get sick.” And on Tuesday, former Senators Tom Daschle and Bill Frist issued a statement opposing the repeal. Frist noted that the ACA echoes both the plan put into place in Massachusetts by Republican Mitt Romney and the national plan proposed in 1993 by former Senator Bob Dole (which was opposed back then by Democrats like Hillary Clinton and Ted Kennedy). (WVFC’s Susan Baida and John Mills explained the plan for us here.)

The complexity of what’s to come, and the level of uncertainty about its success, has made many doctors uneasy despite the AMA endorsement. Others question the math behind the plan’s budget estimates and further claims. For example, Atlantic economics editor Megan McArdle questioned that pre-existing-conditions figure, asking why, with such need, many of the new state high-risk pools are undersubscribed.

Both the slow timeline and the complexity of the plan spring from the fact that those goals Cohn mentioned are difficult to reconcile. The result is a sort of Rube Goldberg contraption: To cover everyone, including those pre-existing conditions, you pretty much need everyone in  common insurance pools,  which then leads to the mandate that everyone hates and the subsidies that some find suspect. Meanwhile, the huge growth of health-care costs is slowed by those suddenly controversial changes in Medicare funding and by encouraging innovative care models like those mentioned in this week’s New Yorker. The nature of each of the components  is perhaps worth discussing and revising over the next few years. But the House of Representatives decided to focus on the “repeal” portion of their promise, deferring the “replace” portion by tasking it out to four separate committees.

Meanwhile,  since the Senate and President Obama are unlikely to complete the repeal, the House majority knows it can instead starve the machine — refusing to support, in the next budget, items that help underwrite the plan’s fulfillment. The 2.5 trillion in cuts just proposed by one of  the House budget committees starts by keeping all non-defense spending “at 2006 levels.” That means no funding to set up the planned exchanges, community health centers, and increased Medicaid funding. It also means no money to implement even the provisions that have already taken effect: no more free preventive screenings, tax credits to help small businesses insure their employees, or funding to help seniors pay for prescription drugs. It also means no increased HHS staff to ensure that no children are barred for preexisting conditions or that insurers meet the new requirement that 80 percent of premiums go directly to patient care. This week’s vote was symbolic, but the Affordable Care Act is on life support.

Those of us who care about the nation’s 40 million uninsured — who are more likely to be female and over 50 —  must watch carefully what comes out of those committees working on the “replace” part of the House process. We get why some health reform supporters are demanding that those who vote for repeal renounce their own, very comfortable, government-provided health insurance.

At the very least, we must demand that those committees  issue their proposals before the budget is finalized, and that those proposals go beyond the usual suspects (for instance, tort reform and wiping out state insurance laws by allowing insurance to be sold across state lines, a true race to the bottom). With only 18 percent of Americans willing to junk the ACA entirely,  it is irresponsible for them to do less. This week’s vote had better not be a dumb show for a drama to come that ignores the needs of the most vulnerable.

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