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Why health reform won't be repealed

By Aaron Carroll, Special to CNN
  • Aaron Carroll says House will vote to repeal health overhaul but law won't be repealed
  • He says former foes in health care lobby fared well in final law, don't care to push repeal
  • When Senate fails to take up repeal, GOP will likely turn to making small changes, he says
  • Carroll: If that succeeds, it'll leave behind most popular parts, won't strengthen GOP's hand

Editor's note: Dr. Aaron E. Carroll is an associate professor of pediatrics at the Indiana University School of Medicine and director of the university's Center for Health Policy and Professionalism Research. He blogs about health policy at The Incidental Economist.

(CNN) -- This week, the House of Representatives plans to vote to repeal the Patient Protection and Affordable Care Act. It will succeed.

H.R. 2, the Repealing the Job-Killing Health-Care Law Act, will absolutely, positively receive the required number of votes to pass.

But this law will not be repealed.

I'm sure there are many people across the country who will feel some measure of vindication anyway. They will see this move as a necessary step in getting rid of the law. They will likely feel satisfaction and cite this vote as progress.

But this law will not be repealed.

I'm not even talking about the short term, where it's impossible for the law to be repealed. Not only won't it pass the Senate -- it won't even receive a vote in that chamber. Not to mention that even if it did, it would most certainly be vetoed by President Barack Obama.

I'm saying that this law won't be repealed, even in the future.

Ironically, if H.R. 2 had a chance of succeeding, I think it's likely that it wouldn't even get a vote. You see, for years, those who advocated for reform complained that the vast, powerful forces of the health care lobby stood in the way of progress. They claimed that those industries were denying health care reform that people wanted.

Now things have reversed. Those same forces, which for so long opposed reform, are now opposing repeal.

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First up is the insurance industry. In the past, they fought reform, and they even fought many steps of the Patient Protection and Affordable Care Act along the way. But the truth of the matter is that things could have been so much worse for them. We could have passed a public option.

Worse (for the insurance industry, at least), we could have seen a real fight for a single-payer plan. Both of these would have potentially sounded death knells for the private insurance companies. Instead, we wound up with a law that, instead of eradicating private insurance, expands it -- along with subsidies for millions more people to buy private insurance.

Now you have insurance executives saying at last week's JP Morgan Health Care Conference in San Francisco that the law represents a "boon" in terms of extending both the individual health insurance market and Medicaid expansions.

The insurance industry doesn't want this law repealed.

The pharmaceutical industry has, for a long time, opposed health care reform. But again the outcome could have been so much worse for them. The law didn't change anything about drug pricing or Food and Drug Administration regulations. Instead, it closed the Medicare doughnut hole, making it easier for senior citizens to buy drugs, and provided tens of millions of people with insurance that can be used to buy their product.

The pharmaceutical industry doesn't want to see this law repealed.

The American Medical Association has been blamed many times for opposing or killing reform. It almost prevented Medicare from happening in the first place. The outcome could have been worse for the AMA, too. There could have been payment reductions, threats of forgoing a "doc fix," or hindering of practice. Instead, reimbursement for a number of services went up. Medicaid payments were increased. Co-pays were also reduced, encouraging many to seek more services.

The AMA opposes repeal, too.

Barely half of the American people want to see the law completely repealed, either. Polls show many Americans believe that the bill didn't go far enough, not that it went too far. Many are too tired of the fight to want to start over. And, while the law may not be universally popular, many aspects of it are.

A recent government report concluded that up to half of people under the age of 65 have a chronic condition. Believe me when I say that the law's regulations that make sure these people cannot be denied insurance or charged more for it will be very, very popular in the future. Parents will love the provisions that allow children to stay covered until age 26. The exchanges will revolutionize the individual insurance market. Seniors will love the new prescription drug benefits.

When the repeal effort fails to gain traction, many in Congress will turn to small changes to weaken the law. They may attack the mandate (although the insurance industry will fight that). They may go after other aspects that are relatively unpopular. But the danger there is that if they remove the "bad" pieces, then what's left will be more popular than unpopular. What's left will be more likable.

By attacking the law piece by piece, they will make it even harder to repeal in the future. Those who are fighting to weaken the law may wind up strengthening it in the long run.

Because, if they succeed, years in the future they will likely be fighting a law that is less unpopular. They will have less support from Americans to repeal what's left. And they will also face the awesome might of the insurance industry, the pharmaceutical industry and the AMA.

This law will not be repealed.

The opinions expressed in this commentary are solely those of Aaron Carroll.