Repub­li­cans strate­gize at­tack on Oba­macare if they win the Se­nate

Modern Healthcare - - NEWS - By Paul Demko

Count on two years of in­ten­si­fied bat­tles over Oba­macare if Repub­li­cans win con­trol of the Se­nate in next month’s elec­tions, which poll­sters say they have a bet­ter-than-even chance of achiev­ing.

An ob­scure but crit­i­cal re­form pro­vi­sion likely to come un­der im­me­di­ate at­tack is risk cor­ri­dor pay­ments to health in­sur­ers. Those pay­ments, es­tab­lished by the Pa­tient Pro­tec­tion and Af­ford­able Care Act, en­cour­age in­sur­ers to par­tic­i­pate in the re­formed in­di­vid­ual and small-group mar­kets by shield­ing them from ma­jor losses if cus­tomers turn out to be sicker and costlier than an­tic­i­pated. With­out them, in­sur­ers might with­draw from the mar­kets.

Repub­li­cans have blasted the pay­ments as a “cor­po­rate bailout” for big in­sur­ers. “There’s go­ing to be a big show­down over the risk cor­ri­dors,” said Chris Con­deluci, a for­mer top Repub­li­can Se­nate staffer who now runs a pub­lic af­fairs firm.

That’s just one of many likely flash­points if Sen. Mitch McCon­nell (R-Ky.) wins his close re­elec­tion contest, be­comes Se­nate majority leader and teams up with House Speaker John Boehner (R-Ohio) to lead a strength­ened fight against Pres­i­dent Barack Obama over the ACA and other health­care is­sues. If that hap­pens, po­lit­i­cal ex­perts ex­pect the par­ti­san cli­mate in Wash­ing­ton to get even more toxic.

That could sig­nif­i­cantly heighten un­cer­tainty for health­care in­dus­try stake­hold­ers, most of whom have spent con­sid­er­able time and ef­fort align­ing them­selves with health­care re­form and want to see it im­proved but not re­versed.

It’s un­clear whether House and Se­nate Repub­li­cans would be able to agree on an al­ter­na­tive re­form pack­age. Some Repub­li­cans fa­vor broad leg­is­la­tion in­clud­ing tax cred­its to ex­pand cov­er­age, while oth­ers have pushed for nar­rower changes such as al­low­ing in­sur­ers to sell plans across state lines. But any GOP re­peal-and-re­place bill would run the risk of caus­ing mil­lions of Americans who have re­ceived health in­surance un­der the ACA to lose their cov­er­age, which is a recipe for po­lit­i­cal trou­ble.

It’s also ex­pected that any new Se­nate Repub­li­can leader would have a hard time keep­ing the party’s right flank in line. That could make it dif­fi­cult for GOP lead­ers to do any­thing that could be viewed as im­prov­ing the ACA rather than killing it.

Early on, most ob­servers ex­pect a vote to re­peal Oba­macare since Repub­li­cans re­peat­edly have promised to do so. But any such leg­is­la­tion to dis­man­tle the law would have to first over­come a Se­nate fil­i­buster by Democrats, and then would face a cer­tain Obama veto. After that, ob­servers

“There’s go­ing to be a big show­down over the risk cor­ri­dors.” CHRIS CON­DELUCI, FOR­MER REPUB­LI­CAN SE­NATE STAFFER

pre­dict Repub­li­cans will try to pick off un­pop­u­lar pro­vi­sions of the law that some Democrats also op­pose and that pro­vide sig­nif­i­cant fund­ing for cov­er­age ex­pan­sions. The most likely tar­gets are the in­di­vid­ual and em­ployer man­dates, the 2.3% ex­cise tax on med­i­cal de­vices and the health in­surance tax.

James Capretta, a vis­it­ing fel­low at the con­ser­va­tive Amer­i­can En­ter­prise In­sti­tute, pre­dicted Repub­li­cans also will fo­cus on ad­dress­ing the can­cel­la­tion of health plans that don’t com­ply with ACA cov­er­age re­quire­ments.

If Repub­li­cans take the stan­dard leg­isla­tive route, they would need 60 Se­nate votes to over­come a Demo­cratic fil­i­buster, though they could change the fil­i­buster rules. That’s why some ob­servers pre­dict they in­stead would use the com­plex bud­get rec­on­cil­i­a­tion process, which re­quires only 51 votes.

But Con­deluci is skep­ti­cal about the rec­on­cil­i­a­tion process. The end re­sult, he said, would almost cer­tainly be a pres­i­den­tial veto—though that could lead to a bud­get show­down in­volv­ing a gov­ern­ment shut­down. In ad­di­tion, us­ing rec­on­cil­i­a­tion means that House and Se­nate Repub­li­cans would have to unify around a bud­get, which has proven dif­fi­cult for them.

Con­deluci thinks a more likely course will be for Repub­li­cans to hold a se­ries of votes un­der stan­dard leg­isla­tive rules to strike down im­por­tant pro­vi­sions of the law, forc­ing Democrats to go on the record vot­ing against re­peal. “The ACA isn’t go­ing to change much, even with a Repub­li­can Se­nate,” he said. “The Repub­li­cans will work to frame the de­bate be­tween now and the 2016 elec­tions.”

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