Noise, not ac­tion, likely as Congress gets back to busi­ness

Modern Healthcare - - NEWS - By Shan­non Much­more

With Congress re­turn­ing from its sum­mer re­cess this week, Repub­li­cans in­tent on de­mon­strat­ing their op­po­si­tion to the Af­ford­able Care Act should have plenty of op­por­tu­ni­ties.

Be­fore the end of the month, law­mak­ers will have to re­solve their an­nual bud­get im­passe. Whether they pass a bud­get (un­likely) or another con­tin­u­ing res­o­lu­tion, the bud­get de­bate of­fers a per­fect ve­hi­cle for chip­ping away at sev­eral health law taxes whose re­peal has gained bi­par­ti­san sup­port. There is also grow­ing sen­ti­ment for chang­ing the ACA’s un­pop­u­lar small-busi­ness man­date.

As pres­i­den­tial can­di­dates from the con­gres­sional ranks look to make news, those hot-but­ton health pol­icy is­sues could see vo­cif­er­ous de­bate.

But the red-meat is­sue an­i­mat­ing the so­cial con­ser­va­tive wing of the GOP—de­fund­ing Planned Par­ent­hood—stands in the way of mak­ing even mi­nor changes in the law, which oth­er­wise might be achiev­able. Party hard-lin­ers in­tent on grab­bing the spotlight will get their chance start­ing Wed­nes­day with con­gres­sional hear­ings.

Planned Par­ent­hood has come un­der with­er­ing as­sault since an anti-abor­tion group’s un­der­cover videos showed staffers dis­cussing fe­tal tis­sue do­na­tion. “I think this is go­ing to be an ugly, ugly pe­riod,” said Brook­ings In­sti­tu­tion se­nior fel­low Henry Aaron. He called the hear­ings a po­lit­i­cal in­stru­ment, not a leg­isla­tive ve­hi­cle.

So suc­cess in mak­ing mi­nor changes to the Af­ford­able Care Act—any­thing ma­jor will face a pres­i­den­tial veto—will de­pend on whether Repub­li­can lead­er­ship can keep its con­ser­va­tive wing in check. GOP lead­ers say they don’t want a gov­ern­ment shut­down. Law­mak­ers like Sen. Or­rin Hatch (R-Utah) have said they would like to tar­get the health law tax mea­sures specif­i­cally rather than in­sist ex­clu­sively on a full re­peal of the ACA.

Tim Jost, emer­i­tus law pro­fes­sor at Washington and Lee Univer­sity, said ACA changes, es­pe­cially nix­ing a man­date to ex­pand the small-group in­sur­ance mar­ket to in­clude busi­nesses with up to 100 em­ploy­ees, are cer­tainly pos­si­ble if un­ten­able riders aren’t added.

It’s a change Pres­i­dent Barack Obama and other Democrats are more likely to go along with so long as it doesn’t in­clude other un­ac­cept­able pro­vi­sions. “The ques­tion is whether lead­er­ship can pres­sure the mem­bers to do a clean bill,” Jost said.

Those who want to get rid of the man­date ar­gue that while it might lower costs for the cur­rent small-group mar­ket that cov­ers busi­nesses with 50 or fewer em­ploy­ees, it would raise costs for those with 51 to 100 em­ploy­ees. Those busi­nesses would also have to find new in­sur­ers that of­fer small-mar­ket plans, which have dif­fer­ent re­quire­ments than large-group plans.

The “Cadil­lac” tax on high-end in­sur­ance plans is also un­der bi­par­ti­san po­lit­i­cal fire. Re­cent stud­ies show that about a quar­ter of em­ploy­ers who of­fer health plans would be sub­ject to the tax, which goes into ef­fect in 2018.

Op­po­nents in­clude in­sur­ance com­pa­nies and la­bor unions, which con­tend the tax will force em­ploy­ers to re­duce ben­e­fits, nar­row provider net­works or drop flex­i­ble spend­ing ac­counts. Demo­cratic pres­i­den­tial front-run­ner Hil­lary Clin­ton has said she wants to “re-ex­am­ine” the tax.

The ma­jor dif­fi­culty is the $87 bil­lion bud­get hole that would be cre­ated by re­peal­ing the tax. Robert Laszewski, a healthcare in­dus­try con­sul­tant, pre­dicts some sort of lim­i­ta­tion on high-cost plans must stay in place to keep the bud­get im­pact low. Any leg­is­la­tion that passes would be more of a po­lit­i­cal state­ment than a pol­icy change, he said.

The ACA’s med­i­cal-de­vice tax, whose re­peal also has bi­par­ti­san sup­port, could also gain trac­tion. Hatch, who chairs the Se­nate’s health com­mit­tee, has promised to con­sider its re­peal as part of a bud­get rec­on­cil­i­a­tion bill.

But, again, re­peal­ing that tax would leave a bud­get short­fall of $30 mil­lion over 10 years. The White House has pledged to veto any mea­sure with­out re­place­ment rev­enue.

Bill Gal­ston, se­nior fel­low at the Brook­ings In­sti­tu­tion, said the de­vice tax re­peal is more likely to pass than the Cadil­lac tax re­peal, but nei­ther is a sure thing. “I can’t rule it out but I don’t know what kind of odds to at­tach to it,” he said.

But the is­sue that could swamp any bi­par­ti­san ef­forts is the threat to shut down the gov­ern­ment over fund­ing for Planned Par­ent­hood. The Con­gres­sional Re­search Ser­vice re­ported that the not-for-profit agency, which re­ceives a ma­jor­ity of fund­ing from non­govern­ment sources, would still re­ceive money from Med­i­caid and state and fed­eral mul­ti­year grants, even if the con­ser­va­tives in Congress force a shut­down.

Gal­ston pre­dicted Se­nate Ma­jor­ity Leader Mitch McCon­nell (R-Ky.) will min­i­mize the time spent dis­cussing Planned Par­ent­hood since he doesn’t have the votes to over­ride a pres­i­den- tial veto. But he may bring a bill to the floor as a ges­ture to the party base. An­a­lysts say the 2016 pres­i­den­tial cam­paign will soon over­shadow con­gres­sional acts, if it hasn’t al­ready. “We’re in the elec­tion kabuki dance,” Laszewski said.

Planned Par­ent­hood sup­port­ers protest Utah Gov. Gary

Herbert’s de­ci­sion to de­fund the or­ga­ni­za­tion.

Se­nate Ma­jor­ity Leader Mitch McCon­nell may min­i­mize the

time the Se­nate spends de­bat­ing Planned Par­ent­hood.

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