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Congressional Republicans Gearing Up to Fix Obamacare


In the wake of the landslide Republican victory in the midterm Senate and Congressional elections, the stage is set for renewed attempts for pragmatic reform of the Affordable Care Act.

In the wake of the landslide Republican victory in the midterm Senate and Congressional elections, the stage is set for renewed attempts for pragmatic reform of the Affordable Care Act.

Lacking the veto-proof 60-seat majority in the Senate necessary for full repeal of the ACA, Senate Majority Leader Mitch McConnell has indicated he will make full use of the legislative tools at his disposal, including the budget reconciliation process (which requires only 51 votes) to make “targeted attacks” on unpopular provisions of the ACA. Elements of the ACA that garner support from both sides of the aisle, such as inclusion in spite of pre-existing conditions and the elimination of caps, will likely not be challenged.

An article in National Journal identifies several examples, including the tax on medical devices and the tax on insurance policies as potential “low-hanging fruit.” Noting that “device-tax repeal could have passed the Senate with bipartisan support even before Tuesday's elections, had it come up for a vote, and it could definitely pass under a GOP majority,” the President might even sign such a bill because “it wouldn't strike at the heart of the law.”

Another possibility for reform that could attract support from several moderate Senate Democrats would be to modify unpopular aspects of the employer mandate, such as changing the definition of “full-time employee” from 30 hours per week to a realistic 40 hours, which would be more amenable to small businesses. According to the National Journal, outright repeal of the employer requirements might enjoy limited bipartisan support but not from the administration, “allowing the GOP to argue that it's pursuing bipartisan ideas while Obama stands in the way.”

The House of Representative, under the leadership of Speaker John Boehner, is also gearing up to take on the ACA. Boehner told the New York Times that although he doubts full repeal of the ACA would pass the Senate, he believes “bipartisan support exists for the repeal of several ACA provisions, such as the medical device tax and the individual mandate.”

An article in Business Insider claims that Republican Senators are ready “to take aim at so-called risk corridors in the health law.” This aspect of the law makes it easier for insurance companies to “transition to the new healthcare system, largely by making it less financially risky for them to sell new insurance plans on the government exchanges” established by the ACA. Republicans have repeatedly labeled the provision a “bailout” for insurance companies, and think “a bill targeting the provision is something they think could attract Democratic votes to get past a 60-vote filibuster firewall.”

Medicaid expansion, which so far has been responsible for the largest percentage of newly insured Americans under the ACA, is likely off the table in several states, including Kansas, Maine, Wisconsin, Florida, and Arkansas.

While total repeal of the ACA may be unrealistic at this time due to the veto power of the President, meaningful reforms to improve its performance and reduce its negative impact are possible. The new Congress will have the opportunity to improve this law while retaining the features that improve America’s health care insurance system.

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Victor J. Dzau, MD, gives expert advice
Victor J. Dzau, MD, gives expert advice