Monday, November 10, 2014

What to expect new Congress to do about the ACA

Now that Tuesday's election has passed and Republicans have control of Congress, many are speculating about how they will challenge the Affordable Care Act, Drew Altman, president and chief executive officer of the Kaiser Family Foundation, writes for The Wall Street Journal.

"There will be early 'statement legislation' to repeal the law and possibly to repeal the ACA's individual mandate, a linchpin of the law that spreads risk and makes its insurance market changes work," Altman reports. However, if the statement legislation passes, President Barack Obama will veto it.

That attempt will likely be followed by legislative efforts to undermine the ACA in more subtle ways. One example might be, John Boehner said Thursday, repealing "the Independent Payment Advisory Board, a not-yet appointed commission with power to trigger reductions in Medicare payments if spending increases exceed certain levels and Congress does not come up with an alternative approach," Altman writes. Also the requirement for larger employers to cover their workers or pay a penalty could be repealed, possibly by changing the definition of full-time workers for 30 hours per week to 40. Sen. Mitch McConnell mentioned Wednesday that they may try to get rid of a medical device law that currently helps finance the law.

However, these proposals don't change the main functions of the ACA: its coverage expansions and insurance reforms, which will probably continue, even if some changes are made. "For most people, opposition to the ACA isn't about the details; Obamacare is mainly a proxy for their dislike of the president and their unease about the nation's direction," Altman writes. Business and medical device makers and insiders would be the ones primarily concerned about the specificities of the legislative proposals to chip away at the ACA.

Currently, small businesses do not have to provide insurance for their workers, and most large companies do that anyway. It's important to keep the changes in perspective because repealing the employer mandate, for example, would not have that much of an impact. "As proposals to modify the ACA are introduced in the new Congress, it will be critical for the media to provide perspective, explain what proposals mean for people and distinguish between small changes and ones that would cut to the core of the law," Altman writes. (Read more)

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