Flush with victory from last November's midterm election, Republican strategists are delving into possible measures to repeal or significantly hamper existing health care reform legislation.
In the House, the GOP gained 60 seats for a controlling 243 members vs. 192 for Democrats.
Democrats, however, retained a narrow grip on the Senate, by a 53 to 47 margin over Republicans.
Republicans feel empowered to make bold changes in the nation's legislative direction, as the midterm results in the House saw the largest party turnover in more than 70 years. Voters apparently agree: a USA Today/Gallup poll of 1,500 likely voters released Nov. 1, 38% of Republicans said repealing the health care law should be the top legislative priority next year.
How might they go about it? After speaking with experts, EBN has compiled a list of five things Republicans might do to disrupt the implementation of the Patient Protection and Affordable Care Act.
1. Repeal and replace.
Despite presumptive Speaker of the House John Boehner's call for repeal, Daniel Sulton, partner with Ford & Harrison LLP, believes this is a long shot.
In the realm of possibilities, this option "probably ranks pretty low on the list," he says. After all, the Republican Party does not have sufficient votes to push repeal through the Senate, and even if they did the president would exercise his veto power and neither Houses of Congress would be able to override a veto.
"A lot of [the repeal-and-replace language] was campaign rhetoric. Realistically, the president is not going to sign legislation that significantly alters his signature legislation," says Steve Wojcik, vice president of public policy at the National Business Group on Health.
2. Piecemeal 'tweaks.'
The president himself says he's willing to "tweak" aspects of the law, and most likely this is the approach to hinder reform that would have the greatest impact, experts predict.
"I think we'll see a lot of compromise, a lot of mending of the legislation or perhaps even releasing certain provisions, but certainly not a repeal of the entire legislation," says Sulton.
Provisions most likely to be addressed would be the individual mandate, "play or pay" requirement for employers, and medical loss ratio.
3. 'Starvation.'
In what Sulton refers to as "starvation," House Republicans could decide not to appropriate funds to develop further PPACA regulations.
By delaying a provision, as seen with the W-2 reporting requirements, fees could be delayed, reduced or eliminated altogether. The issue is whether it will have a mitigating effect on the implementation of health care reform, Sulton wonders.
4. Legal challenges and investigations.
Legal suits have already been filed by 21 states, declaring primarily that the individual mandate is unconstitutional. This issue most likely will make its way to the Supreme Court, experts predict, though they don't expect it to slow the implementation process.
Additionally, the government oversight committee can subpoena and investigate administration agencies. They may, for example, examine more closely how the White House struck deals with the health care industry, specifically with hospitals and physicians.
5. State-level intervention.
Due to large GOP gains in gubernatorial and state legislature contests, state Republicans leaders could begin to pass mandates stating that the states would not be obligated to enforce an individual mandate or incur additional expense on health care reform.
The Republican majority of governors are tasked with implementing Medicaid expansions as well as the state-run health insurance exchanges for small businesses and the uninsured. They could decide how many resources go into developing exchanges with the option not to develop exchanges and leave their set up to the federal government.
"The states have a significant role in implementing this health care law in terms of the exchanges and the Medicaid expansions," says Wojcik. "The elections have profound implications at the state level, possibly even more than the congressional level here in Washington."
Whether this will be a top priority in Congress remains to be seen. Sulton guesses that Congress will attempt to address unemployment at the same time as health care reform due to the intertwined nature of the two.
Wojcik believes Congress will primarily focus on jobs and adds that it wouldn't be wise for lawmakers to spend too much time on health care repeal or retardation because if they do, then they will be in the same position the prior Congress was in. After all, exit polls show that while health care reform was an issue in the midterm elections, it was not a decisive factor. He concludes that Republicans will work "around the edges," delaying the implementation of the landmark legislation.
This means confusion and uncertainty for employers, says Sulton. Employers are unsure whether upcoming implementation dates will come to pass, but Sulton expects them to continue making changes based on current law.
