If I can leap ahead a bit here, in anticipation of Harry Reid actually passing health care reform (something that is far from assured), the Democrats are going to have to defend their votes for this bill, while the Republicans will have to defend their votes against it. Because a lot of the provisions of this reform will not come to fruition until 2013 or 2014, the debate over this vote is going to be largely theoretical during the 2010 and 2012 election cycles. To be honest, most of the people who will eventually get health insurance (and the subsidies to pay for it) are more likely to vote for Democrats than Republicans anyway. They have lower income levels and pay little to no federal income tax. Once they have insurance in hand, they’ll probably be modestly more likely to vote, but we shouldn’t expect to see any immediate boon in the Democrats’ fortunes from this group.
The selling point for this reform is not going to be that it provides insurance to the uninsured. The popular parts of the bill are going to be the pieces that apply to everyone. The end of recissions, no more worries about preexisting conditions, caps on out of pocket expenses, and increased portability. The way to put Republicans on the defensive is to ask them why they wanted the insurance corporations to be able to continue to screw the consumer. The Republicans will try to talk about the cost of reform, but they’ll have a hard slog in the face of CBO estimates that the reform will actually improve the budget deficit and bend the cost-curve of providing health care to people.
The main tangible evidence that voters will have to assess this reform in the short-term will be the cost of their insurance. If it is still going up rapidly every year, they’re going to be pissed off and dubious that anything positive has been accomplished. This is the main risk of postponing many of the cost-cutting provisions through two election cycles. On the whole, Democrats should be able to win the short-term political argument over whether this reform was a good or a bad vote, but it won’t be a slam-dunk. As the Democrats put the finishing touches on this legislation during the Senate debate and the Conference Committee, they should keep an eye on the short-term political consequences as well as the long-term policy considerations. If the Republicans make any gains in the 2010 Senate elections, we’ll see very little positive reform in 2011 and 2012. So, passing the bill is the most important thing, but making sure it is possible to sell the bill politically in the short-term is also critical.
