Republicans' First Order Of Business May Be Chipping Away At Obamacare

May 28, 2014
Originally published on November 6, 2014 3:33 pm

Now that the Republicans control the House and Senate, they've got their eyes on the Affordable Care Act. Which parts will President Obama veto and which parts will he inevitably have to give up? Melissa Block talks to Mary Agnes Carey, a senior correspondent for Kaiser Health News.

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We just heard Speaker Boehner say that House Republicans intend to repeal the Affordable Care Act. And now that Republicans will also control the Senate, the incoming Majority Leader Mitch McConnell has promised to do the same. Republicans know Pres. Obama would veto major changes to the law, but they've proposed other steps to chip away at it. Mary Agnes Carey of Kaiser Health News came by the studio to lay out potential changes we might see in the law's provisions, starting with the 2.3 percent tax on medical devices like artificial hips and pacemakers.

MARY AGNES CAREY: You could imagine the medical device industry hates this. They think it's a job killer, it's terrible. And they've gotten some support, a lot of support actually, on the hill from Democrats and Republicans. But here's the problem - it fills about a $28 billion revenue hole over 10 years. So if you repeal the medical device tax, you have less money to finance the health care law and, also, the other industries that are taxed in the law are certainly going to come up and ask for their reductions, whether it's the health insurers, the drug makers and so on.

BLOCK: So they would say if you repeal this tax, what about me? Where's mine?

CAREY: Exactly.

BLOCK: Something else that Republicans have said they want to chip away at is the employer mandate and that requires companies to provide health insurance if they have more than 50 full-time employees - people defined as working at least 30 hours a week. Some Republicans say let's make that 40 hours. Do you see room to compromise with the Obama administration on that?

CAREY: Well, the Obama administration has actually delayed this twice. It'll just take effect for some employers January 2015. I know there's January 2016. Another point in favor of repeal is the vast majority - well over 90 percent - of companies with a hundred or more workers already provide health insurance for their employees. On the other side of the ledger is the money. There is an employer responsibility fee - you have more than 50 workers, you don't cover that and one of your workers gets a subsidy and goes and buys health insurance in the exchange. If it were repealed, you wouldn't have that money to help finance the law.

BLOCK: In laying out possible changes that he would want to see, Speaker Boehner said how about the individual mandate - that's the mandate that requires most Americans to buy health insurance or pay a penalty. Of course, take the individual mandate away and the president would surely veto that. That's at the heart of his plan. Could the law work without the individual mandate?

CAREY: It seems like it would be awfully difficult because the problem is if you don't require most Americans to buy insurance or pay a fine then the people who are signed up for health insurance are going to the sick folks. And, of course, you need something called the risk pool where the healthy and the sick workers balance each other out. So taking away the individual mandate could cause a lot of problems for the health law.

BLOCK: If you think forward to the end of the Obama administration, do you imagine that the Affordable Care Act - will it be recognizable? Will it be mostly the same, chipped around about the edges or will it be fundamentally altered?

CAREY: I think it will survive mostly intact for this reason - you have millions of people now getting health insurance on the insurance exchanges through the Medicaid program. Millions of adult children up to age 26 can now stay on their health insurance plan. People like that. They like the idea of no more lifetime or annual caps on essential health benefits. It would be very hard to gut those provisions because so many people benefit from them. But as we're hearing in the last couple of days, there may be some political agreement on some measures, some tweaks, in the health care law and Democrats and alike have said they'd like to make some changes but we've had such a politically polarized environment. With Republicans now controlling the Senate and the House, there may be more room to make changes where the law survives mostly intact, but with a few changes.

BLOCK: And do you think Republicans, though, would be satisfied with that when they have said they want to repeal this, as Mitch McConnell says, root and branch? Tinkering around the edges may not be enough for them.

CAREY: But the problem is they don't have the votes. They will control the Senate, but they won't have 60 to stop a filibuster. They won't have a veto-proof majority. So politics in and of itself is the art of compromise. And this will certainly be tested with the Republicans when it comes to the Affordable Care Act.

BLOCK: Mary Agnes Carey, senior correspondent with Kaiser Health News. Thanks so much.

CAREY: Thank you. Transcript provided by NPR, Copyright NPR.