Next Obamacare Fight Has Peril for Both Sides
As President Barack Obama and congressional Republicans profess to search for common ground, both sides are preparing to lob grenades: the president with an executive action on immigration, the new Congress by making the repeal of Obamacare one of its first initiatives.
The furor over an immigration action, which some Republicans charge would be an impeachable offense, is overdone. Whatever Obama does could be overturned by Congress or rescinded by the next president; that's the nature of executive actions.
And a move to repeal the Affordable Care Act is merely a sop to the Republican Party's right-wing base. It isn't likely to get through the Senate, and it certainly wouldn't overcome a presidential veto.
But there will be changes to the health-care law in the Republican-controlled Congress. The nature and scope of those adjustments will have important implications for health care and politics.
There is some low-hanging fruit for Republicans, starting with the small tax on medical-device makers that helps fund Obamacare. Most studies indicate that the levy, which will raise $29 billion over 10 years, creates little hardship for the industry.
Nonetheless, device makers have waged an intense and effective lobbying campaign against the tax. And its repeal is now supported by liberal Democrats such as Amy Klobuchar and Al Franken of Minnesota, as well as Elizabeth Warren and Ed Markey of Massachusetts, whose states are home to manufacturers. The repeal effort is likely to sail through Congress and probably wouldn't face a presidential veto. The only question is whether the fiscal watchdogs in Congress would replace it with a comparable revenue source.
There is also a Republican proposal to change the definition of full-time work. The plan would allow employers to avoid providing health-care coverage to workers who put in less than 40 hours a week, up from 30 hours now. A compromise is likely.
Given that a fairly large number of workers might be reclassified as part time, it might make more sense to replace the entire employer mandate. But that's politically difficult because it would be virtually impossible to find a way to take care of those who would lose their coverage.
But any move to alter the individual mandate would face a certain White House veto. Ironically, it was initially a Republican idea: It was the cornerstone of former Governor Mitt Romney's health-care plan in Massachusetts.
"We have known for 70 or 80 years that voluntary health-care insurance is a failure; it has to be mandatory," said Zeke Emanuel, a former top Obama health-care adviser who is now a vice provost at the University of Pennsylvania.
There are two other less noticed provisions of the huge bill that have been targeted by big drug makers, hospitals, the American Medical Association and congressional Republicans. The first is the independent payment advisory board that would recommend cuts to the program (subject to congressional approval) if Medicare inflation becomes excessive. The second is the Patient-Centered Outcomes Research Institute, which analyzes the effectiveness of medical treatments.
Possibly the biggest threat to Obama would be if the Supreme Court threw out subsidies for people who don't qualify for Medicaid. This would affect the federal exchanges, which are operating in 37 states. It wouldn't have any impact in 13 states and the District of Columbia that run their own exchanges.
There is danger for Obama in how all this plays out. Some changes could severely undermine the president's signature domestic-policy achievement.
That would also carry risk for Republicans, however. The public tends to express a negative view of the Affordable Care Act, but individual provisions of the law are gaining support. In a decidedly Republican midterm electorate this month, voters nationally and in battleground states were divided between those who said Obamacare went too far and those who said it was just right or didn't go far enough. If beneficiaries are adversely affected and a conservative majority on the Supreme Court makes what critics will call a partisan decision, there could be a strong backlash.
This column does not necessarily reflect the opinion of Bloomberg View's editorial board or Bloomberg LP, its owners and investors.
To contact the author on this story:
Albert R. Hunt at email@example.com
To contact the editor on this story:
Max Berley at firstname.lastname@example.org