GOP plots Oba­macare agenda if they take Se­nate

Modern Healthcare - - NEWS - By Paul Demko

If Repub­li­cans win con­trol of the Se­nate in Novem­ber, they al­most cer­tainly will vote to re­peal Oba­macare, join­ing House Repub­li­cans in that ef­fort. But there’s zero chance that Pres­i­dent Barack Obama will sign a re­peal bill.

Af­ter that sym­bolic vote, most con­ser­va­tive an­a­lysts ex­pect Repub­li­cans to fo­cus their real en­ergy on re­peal­ing pro­vi­sions of the law that pro­vide sig­nif­i­cant fund­ing for the law’s pre­mium sub­si­dies. Some of those ef­forts could draw Demo­cratic votes.

Top­ping the GOP hit list are the med­i­cal-de­vice tax—pro­jected to yield $29 bil­lion over 10 years to help fund the law’s pre­mium sub­si­dies—and the re­quire­ment that larger em­ploy­ers ei­ther pro­vide cov­er­age for their em­ploy­ees or pay a penalty, which is pro­jected to gen­er­ate $130 bil­lion. Los­ing that rev­enue would blow a big hole in Oba­macare fund­ing.

Eras­ing those pro­vi­sions is likely to get some Demo­cratic sup­port, par­tic­u­larly on the 2.3% de­vice sales tax. Democrats who rep­re­sent states and dis­tricts where med­i­cal-de­vice man­u­fac­tur­ers are lo­cated have op­posed the tax. “It’s been pretty clear there’s a bi­par­ti­san coali­tion in the House and Se­nate that be­lieves the med­i­cal-de­vice tax has been very harm­ful to jobs,” said Rep. Erik Paulsen ( R- Minn.), chief spon­sor of the House pro­posal.

But some ex­perts ques­tion the de­vice in­dus­try’s claims that the tax is hurt­ing com­pa­nies, not­ing that the tax ap­plies to im­ported de­vices, so there’s no fi­nan­cial in­cen­tive for health­care providers to switch to for­eign sup­pli­ers, and that it does not ap­ply to ex­ported prod­ucts.

Repub­li­cans also are likely to push for al­low­ing in­sur­ers to sell health plans across state lines with­out be­ing reg­u­lated in ev­ery state, ar­gu­ing that will drive down pre­mi­ums. But state in­sur­ance com­mis­sion­ers ar­gue that would limit their abil­ity to pro­tect con­sumers against in­sur­ance abuses.

If Repub­li­cans move to re­peal the de­vice tax and the em­ployer penalty, they ei­ther will have to find a way to off­set the rev­enue losses or ac­cept an in­crease in the bud­get deficit. That could rile up fis­cally con­ser­va­tive Repub­li­cans. “Vir­tu­ally any­thing you can think of that might be sen­si­ble bangs up against CBO scor­ing,” said Joe An­tos, a health­care pol­icy ex­pert at the con­ser­va­tive Amer­i­can En­ter­prise In­sti­tute.

“I think, ul­ti­mately, the pres­i­dent will be open to some changes,” said Yev­geniy Fey­man, a fel­low at the con­ser­va­tive Manhattan In­sti­tute who stud­ies health­care is­sues. “But I don’t think rad­i­cal changes are re­al­is­tic while there’s no veto-proof ma­jor­ity or while Obama’s still in of­fice.”

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