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opinion | michael e. capuano

Obamacare is facing death by a thousand cuts

Outright repeal is one way to sabotage health care reform, but most opponents recognize they don’t have the votes for that, let alone enough to override a certain presidential veto. Of course, this has not prevented House Republicans from voting three dozen times to repeal health care reform. A 37th attempt took place earlier this month. All of this represents nothing more than political grandstanding. Since they haven’t been able to achieve an outright repeal, Republicans are also working to thwart implementation.

Over the last three years, the Obama administration and leaders in many states have been preparing for the full implementation of health care reform. At every step, the Republican majority in the House, their committed counterparts in the Senate, and their allies in many state houses across the country have sought to delay, obstruct, and undermine these efforts. Rather than fix the parts of the law that need to be fixed, they plot new ways to kill it by a thousand cuts.

Republicans have denied funding for essential preparations and made it plain they will resist confirmation of presidential nominees needed to administer it. Moreover, the Republican-led House has voted to defund the law and targeted specific aspects of it. They have voted to withhold salaries for employees who will set up health care exchanges, the marketplace where consumers will go to choose a plan. They have voted to repeal funding for school-based health care centers and voted numerous times to eliminate the Prevention Trust Fund. You don’t have to be a doctor to recognize that preventing illness is cheaper than treating it. Eliminating funding for programs like this will result in higher health care costs.

The evidence is overwhelming that Republicans are undermining health care reform whenever possible so that it will either be delayed, incredibly messy, or impossible to administer responsibly. Then, in the run-up to the next national election, they will simply blame Obama and Democrats for passing a bad law while denying they did anything to sabotage it.


Their national echo chamber will magnify those accusations, trying to provide them with the appearance of credibility. If the American public buys into their scheme and elects more Republicans, they may gain enough seats to win outright repeal.

When Medicare drug expansion coverage became law in 2003, Republicans overwhelmingly supported it and Democrats opposed it, including the late Senator Ted Kennedy, the champion of Medicare. The proposal added hundreds of billions of dollars of cost without any money to fund it increase. The outcome of a massive expansion without additional revenue is collapse — bankruptcy through the back door.


A similar path will likely be taken when it comes to some of the more popular aspects of health care reform, such as mandatory coverage for pre-existing conditions. No one will stand up in public to object to the goal, but Republicans will deny all funding needed to actually pay for it, with the same inevitable result: bankruptcy and collapse.

The Massachusetts delegation is vigorously fighting to protect health care reform, but Democrats do not hold the majority in the House, and therefore do not control the agenda.

It’s still too early to be confident that health care reform is safe and implementation will proceed smoothly. There are still too many opportunities for mischief and deceit. The death-by-a-thousand-cuts approach could lead to the collapse of health care reform just as surely as repeal of the law. Those of us who actually believe in basic affordable health care for all Americans must remain diligent, honest, and above all, prepared to continue this struggle for America.

Michael E. Capuano is a US Representative from Massachusetts.