The Republican Case for Health Care Repeal: Certain Uncertainty

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The House of Representatives begins debate today on a bill called “Repealing the Job-Killing Health Care Law Act.” (Speaker John Boehner's office dialed back the language on the legislation in a Sunday blog post, calling it "job-crushing" instead of "job-killing," but the bill's name remains the same.)

To make their case for repeal, House Republicans are honing in on the massive health care overhaul's effect on employment, at a time when that’s the most sensitive issue on American minds.

How does the Patient Protection and Affordable Care Act, which aims to expand health insurance coverage and reduce costs, kill jobs? The Republican majority offers this report, Obamacare: A Budget-Busting, Job-Killing Health Care Law.

The document is packed with facts, figures and footnotes focused specifically on the law’s consequences for business. The numbers are compelling, taken at face value, but therein lies the problem: much of the information cited in the report is just as uncertain and subjective as the Congressional Budget Office (CBO) numbers that Republicans say you can’t trust.

It doesn’t help that they get off to a rather disingenuous start. Among the opening salvos is a quote from the CBO, which Republicans cast as saying the health care law will “reduce the ‘amount of labor used in the economy by … roughly half a percent...,’ an estimate that adds up to roughly 650,000 jobs lost.” Those ellipses are there for a reason. The un-redacted excerpt reads, “reduce the amount of labor used in the economy by a small amount—roughly half a percent—primarily by reducing the amount of labor that workers choose to supply” (emphasis added).

In other words, the CBO is saying that people may choose to work less or exit the workforce entirely if health coverage is easier to afford. The effect would be job openings, not job losses. This was the original justification for Social Security, which was intended to draw seniors into retirement and out of the workforce to make room for the unemployed.

Investigating these claims is a worthwhile endeavor, not because one hopes to prove one side wrong or right, but because this is in the playbook for both parties. There are so many organizations, federations, unions, groups, universities and think tanks that can conduct studies using a tremendous variety of variables and indicators, all in the name of guessing what will happen. We are told the CBO has said X, Y and Z, but their numbers are flawed and here is why. Now, here are some numbers that aren’t flawed that tell the real story. Trust us.

For example, House Republicans also cite a National Federation of Independent Businesses (NFIB) report saying that “the employer mandate alone could lead to the elimination of 1.6 million jobs between 2009 and 2014.” But the employer mandate doesn’t take effect until 2014. The NFIB conducted simulations, and found that a mandate enacted in 2009 (which it wasn’t) could (but not certainly) lead to 1.6 million jobs lost. Nobody knows what the state of the U.S. economy will be in 2014, but we all know that it was terrible in 2009. This is like comparing apples and some other fruit that we don’t even know exists yet.

This goes on. Republicans tout that they have a letter from “more than 130 respected economists,” stating “the health care bill contains a number of provisions that will eliminate jobs, reduce hours and wages, and limit future job creation.” But 20 other economists did the same thing for the other side. To come to any conclusions about who’s right, we’d have to decide if more economists is always better, then we’d need to figure out who each economist was, and even then there’d be some kind of ideological debate without a concrete answer.

There's also a reference to a bevy of new tax forms, where the report quotes the IRS National Taxpayer Advocate, who says, “[T]he new reporting burden, particularly as it falls on small businesses, may turn out to be disproportionate as compared with any resulting improvement in tax compliance.” The full quote? “TAS has not yet reached any conclusions regarding the benefits and burdens of the requirement, but the report expresses concern that the burdens ‘may turn out to be disproportionate as compared with any resulting improvement in tax compliance’” (emphasis added).

The report argues that a tax on medical equipment manufacturers will dig into their profits, without noting that the quoted article also features Sen. John Kerry (D-MA) making the point that with 30 million more customers in the health care industry, profits are also expected to rise. We are told that restaurants and retail operations will see profits decrease as it becomes more expensive for them to provide health care, but not that the quoted article also features a union president who questions their calculations—important, when this debate has seemingly become all about questionable calculations. We are told that a tax credit would help “just three million workers,” when earlier in the report 650,000 jobs was made to seem like a huge number.

The CBO’s accounting methodology is made suspect with claims that its projections only cover the first decade of the law’s existence. Republicans call forecasts for deficit reduction the result of “gimmicks” and say the debt will balloon as a result of the law in the following decade. But the CBO did conduct estimates for 2020 and beyond showing deficits would be reduced “relative to those projected under current law” (emphasis added). It may not eliminate deficits, but it is projected to make them lower than they would be otherwise. Republicans offer their own chart showing how the debt will be affected beyond 2020, and come up with much higher cost projections.

The reality is that we just don’t know. It’s difficult to prove one set of numbers is better than another. Heck, they could all be wrong. But as a coda to the report, Republicans have chosen to highlight uncertainty as the main way “Obamacare” is a “job-killer.” We are given quotes from business owners, small and large, who say that uncertainty regarding the health care law will keep them from hiring and expanding with confidence. But it's an open question whether after reading this report, anyone is left feeling less confident—or just more confused—about the effects of this legislation.