BOSTON Republicans in Congress may not be able to unravel healthcare reform over the next two years, as their leaders have promised, but they can make strategic cuts for now before using the issue as a powerful wedge in the 2012 presidential campaign.
At a panel discussion on Friday at the Harvard School of Public Health, arranged in collaboration with Reuters, health policy experts said the Obama administration's 2010 healthcare law could be nearly unrecognizable within a year.
To view a video of the panel discussion at Harvard School of Public Health, go here
"We will have seen the leading edge of dismantling this bill through the discretionary spending process," said Douglas Holtz-Eakin, a former advisor to Republican John McCain's 2008 presidential campaign.
"It will slow down the implementation and put it on a timetable to be solved in the 2012 elections," said Holtz-Eakin, now president of the policy institute American Action Forum.
On Tuesday, sweeping gains put Republicans in control of the U.S. House of Representatives, raising expectations for an assault on Obama's health law, which was unpopular with many voters in the mid-term elections.
Democrats remain in control of the Senate and White House, supercharging an already toxic political atmosphere.
"We will go through a burning bridge," said David Cutler, a Harvard economics professor and former senior healthcare adviser to Obama's presidential campaign. "I am quite pessimistic after Tuesday about the future of our healthcare debate."
Cutler predicted an "immense stalemate" in 2011. "We will have, or be close to having, a government shutdown, and not have any agreement on how to move ahead on healthcare."
The future of healthcare reform, among other issues, will be discussed next week by top executives from health insurance and pharmaceutical companies, as well as officials from the Obama administration, during the Reuters Health Summit in New York.
A BILL IN PIECES
The healthcare reform law, approved in March, aims to extend medical coverage to more than 30 million Americans who are currently uninsured.
It also imposes tough new standards on health insurance companies such as UnitedHealth Group (UNH.N) and Aetna Inc (AET.N) and requires all Americans to buy health insurance policies starting in 2014 or face fines.
Elements of the bill have been timed to roll out over several years, but many of the provisions might never see the light of day if funding is cut when Congress debates next year's budget, the panelists said.
Robert Blendon, professor of health policy at the Harvard School of Public Health, said pieces of the bill are likely to simply vaporize.
"Things that are not currently funded are easier to cut in the future than things that are. (The choice is) we can not pay doctors tomorrow, we can lay off teachers ... or we can take money out of a bill that most people don't understand."
Cutler did see scope for individual U.S. states to take steps to improve the quality of their healthcare systems based on the reforms, while Blendon said the Obama administration can still push ahead on regulatory implementation.
The panelists agreed that the U.S. healthcare system is riddled with problems and don't address the needs of many of the country's citizens.
Since the U.S. recession started in 2008, U.S. medical care costs have risen faster than any other component of the core consumer price index apart from education.
If lawmakers head back to the drawing board on healthcare after the long, fractious fight that resulted in the 2010 law, no one expects a rapid resolution.