“The outcome of this fight is very much up for grabs,” Mr. Rove said, speculating that the ACA would go down in the House and might fail in the Senate if it came to a vote now. “After the 2012 elections, when the Senate and the White House are up for grabs, it may be possible to undo the potential damage of this bill by getting it off the books and starting afresh.”


Published 1/1/2012
Terry Stanton

Affordable Care Act a “Disaster,” Says Karl Rove

Republican political guru believes repeal and revision of healthcare act is still possible

It’s not too late, Karl Rove told the packed crowd of surgeons attending the 2011 annual meeting of the North American Spine Society. The former adviser to President George W. Bush methodically recited numbers to declare the Patient Protection and Affordable Care Act (ACA) “a disaster”—unworkable, unaffordable, and unfair to physicians and patients.

Karl Rove at the NASS annual meeting.
Courtesy of NASS

Mr. Rove noted that no other major social legislation, including the civil rights law and the creation of Medicare, has fallen in popularity after passage. The one exception is the ACA.

Since the ACA was enacted in March 2010, opposition to the bill has grown to 46 percent of the public—with those strongly opposing it outnumbering those who strongly favor it by 3 to 1.

According to Mr. Rove, the views of many people involved in healthcare partly account for the increased opposition to the bill. “They see negative effects in the bill. They talk about it with their friends and neighbors,” Mr. Rove said. “They have higher credibility on health care than any politician, even the president.”

What’s wrong with the ACA?
The ACA is facing a challenge in the courts, he noted, based on the theory that it violates the commerce clause of the U.S. Constitution because it mandates individuals to buy insurance. The Supreme Court will hear the case and could overturn it based on the “severability clause,” which states that if one part of a piece of intertwined legislation is ruled unconstitutional, the entire act is unconstitutional.

A major, expensive flaw in the bill was the long-term care provision—the Community Living Assistance Services and Supports program, or “CLASS Act,” which the administration eventually decided not to implement.

“The problem was that it was organized in such a way that it was meant to undercut the entire private market,” Mr. Rove said. “As a result it was unsustainable.” Unfortunately, because the administration was counting on the premiums that would be collected during the early years to help pay for the overall bill, the demise of the CLASS Act jeopardizes the future of the ACA itself.

“Almost every major promise made about the ACA is turning out to have some difficulties in it,” Mr. Rove said. Among them is the president’s assurance that passage of the bill would exert downward pressure on insurance premiums—an average reduction of $2,500 for a family of four. Instead, premiums went up by 7 percent to 9 percent in both 2010 and 2011 and are projected to increase for 2012, Mr. Rove said. He pointed to one accounting firm study that projected insurance premiums would increase 111 percent over the next decade, much of it propelled by the additional mandates and requirements of the ACA.

Regardless of what the exact increase might be, “the fact of the matter is that the original promise that this would bring about almost instantaneous downward pressure on premiums has simply not turned out to be true,” he said, adding that one way the bill fuels the increase is that “it requires insurance policies to all look alike.” As many as 80 million Americans may lose coverage, he said.

No help for healthcare costs
Although President Obama touted the bill as a “powerful lever” that would bend the healthcare curve down, Mr. Rove noted the Centers for Medicare and Medicaid Services (CMS) estimated that the nation will spend $311 billion more on health care after passage of the ACA “than we would if we had done nothing.”

A large, mostly hidden feature of the bill—but one recognized by human resource and healthcare professionals, Mr. Rove said—is that “it relies on regulation and price fixing to restrain costs. There is no way to escape that this is going to lead to the rationing of healthcare.”

The long-term price tag of reform, around $1.55 trillion, and the difficulties of complying with the law could drive many physicians out of practice, Mr. Rove said. “Just as we are about to get a lot more older people and just as we put a new system in place whose fundamental promise is that people will have a lot more access to healthcare through insurance, we are now facing the likelihood that a lot of doctors are going to leave.” He urged physicians to get involved.

“Go to your community groups. If people hear how you feel about this, it will make a difference,” Mr. Rove said. “We’ve let this be defined by people who are not physicians, who are not healthcare professionals.”

Earlier, Gregory J. Przybylski, MD, outgoing president of NASS, presented a similarly cloudy outlook to the same group. He noted that premiums and costs will balloon, while reimbursements will decline, and CMS seems poised to put the tightest squeeze on specialists and the procedures they perform.

“Future regulation will be onerous. Future compensation looks gloomy,” he said. He noted that what were first painted as bonuses will turn into penalties, and he warned that the government might criminalize lapses in compliance with regulations. “What I am most fearful of is incarceration,” he said.

Terry Stanton is senior science writer for AAOS Now. He can be reached at tstanton@aaos.org