We can be assured of a more conservative outlook in the House and will surely expect GOP committee chairs toincrease the level of oversight of the Obama Administration. While it is likely there will be a push by the Republicancontrolled House to repeal or replace all or parts of the reform, a full repeal of the reform is unlikely with a Democratic Senate and President Obama’s veto power (the Republicans do not currently have the necessary votes to override a Presidential veto). The Republicans’ best chance of having the law repealed would not likely be until 2012 at the earliest, and would naturally depend on the outcome of that election. Even so, newly elected officials will be under pressure to act and will, at a minimum, work to chip away at the legislation. Although early attempts at repealing the PPACA will be unsuccessful, we are likely to see some retooling of the current provisions. In fact, the morning after the election, Harry Reid, the Democratic Majority Leader, and President Obama were both quoted as saying they would be open to “tweaking” the health care bill Democrats passed earlier this year. So, although many have predicted a prescription for gridlock following the election, there seems to be a “willingness” among some Democrats to seek compromise with the new Republican majority in the House.
What parts of the reform are likely to come under fire?
It’s a good guess that the following provisions are on the Republicans’ radar: employer penalties, individual mandates, Medicare funding cuts and Medicaid expansion. Funding probably has the biggest target on its back – there are approximately 100 key concepts of the law that require federal funding (including grants to states to establish exchanges and subsidies to help individuals purchase insurance on the exchanges). We can expect to see the House push to delay funding in these instances. However, Republicans need to be careful, as there will be unintended consequences resulting from their actions.
Many candidates campaigned that they would repeal the “bad parts” of the law, such as the mandate, but keep the “good” things, such as guaranteed issue, the
elimination of pre-existing condition restrictions and the prohibition on health status rating. These provisons only work if everyone is in the risk pool; otherwise people would wait until they were ill to purchase coverage and would be able to drop it after their recovery without penalty. Without a mandate, premiums will skyrocket, and eventually the individual market will fail. The employer penalty imposed for not offering coverage is also an integral part of the legistlation. Without a penalty and the opportunity to dump employees into the guaranteed issue exchanges in 2014, employers will face a very obvious financial decision: stop offering health insurance. As it stands, the $2,000 penalty may not be enough to stop employers from dumping coverage.
If repealing the law is not an option, what else can be done?
The battleground has moved to the states in most cases. Although Republicans in Congress could seek waivers fromsome of its provisions, states are now the keepers of the keys on the impending exchanges and they will be the ones designing the legislation surrounding them, as well as appointing people to important positions, such as insurance commissioner slots. Further, states may try to slow the reform’s implementation through challenges to the law in federal court, while looking ahead to the 2012 presidential election. Currently, there are 21 states challenging the PPACA in the courts.
Where does this leave us?
Has anything really changed since the election? Are we going to see sweeping changes? Probably not. At this point,notwithstanding the shift in the majority of the House of Representatives, opponents of the PPACA do not appear to have the power to make comprehensive changes. It’s too soon to tell, but anticipate at least
