Wednesday’s vote in the House on repeal of the Affordable Care Act will make clear one more time where each House member stands, but it won’t change the law. Unless Mitt Romney wins the presidency on Nov. 6 and Republicans gain control of the Senate and keep the House majority, the law is on course to take effect, with employer mandates, for example, becoming binding in 2014.
“Our health care law was the right thing to do,” President Barack Obama told a crowd as he campaigned in Cedar Rapids, Iowa Tuesday. “I will work with anybody to improve the health care law where we can, but this law is here to stay.”
J. Scott Applewhite / AP
House Speaker John Boehner of Ohio, and other GOP House leaders face reporters after a closed-door political strategy session.
Oh no, it’s not, contend conservative health care policy experts and leading GOP lawmakers. They say even in their worst-case scenario -- Obama’s re-election -- fiscal pressures will force Congress to rethink the law.
“This is unsettled business. Even if the election goes the way (so) that this president gets re-elected, it’s inevitable that they are going to have to re-open this health care law,” said Nina Owcharenko, director of health policy at the Heritage Foundation, a right-of-center think tank in Washington.
MSNBC's Richard Lui breaks down what happens if certain state governors decide not to go along with the health care law. Strategists Ted Strickland and Rick Tyler discuss.
Speaking alongside other conservative policy experts at a panel sponsored by the American Action Network and Crossroads GPS Tuesday, she said, “I think even in a worst-case scenario, there’s an opportunity” for conservatives to push for their own reforms, such as allowing individuals to carry the insurance tax break with them throughout their career, no matter which firm they work for, or if they’re self-employed.
To win the struggle for the hearts and minds of voters, conservatives aim to persuade middle-income and upper-income workers, 160 million of whom already have employer-provided health insurance, that they’ll be made worse off by “Obamacare.”
When it comes to health care as a campaign issue, the already-insured may be one of the two crucial swing voter groups, the other being the 40 million seniors covered by Medicare.
The already-insured voters are critical because as income go up, so does the propensity to vote: nearly four out of five of those with incomes of $100,000 or more voted in 2008 – while only 54 percent of those with incomes under $30,000 voted. As income goes up, so, too, does likelihood of having employer-provided coverage.
House Speaker John Boehner mocks reporters who continue to ask him why Republicans once again are trying to repeal the 2010 health care law. Msnbc's Craig Melvin reports.
For Republican candidates to win the debate, they must make the case that the 160 million who have employer-provided health insurance will see their plans weakened or ended outright.
One big change the ACA makes is to set up regulated insurance marketplaces or “exchanges” where uninsured people can purchase coverage, using federal subsidies available for families with incomes of up to $92,200 for a family of four.
“I think there’s too much money on the table in these exchanges” for employers to being to resist the opportunity of stopping coverage, paying the penalty for not offering coverage, and letting their workers migrate to the exchanges, said Douglas Holtz-Eakin, who served as chief of the Congressional Budget Office (CBO) under President George W. Bush and now heads the American Action Forum, a conservative advocacy group.
“You’re not doing your job as a business owner or a corporate executive if you haven’t thought: ‘Can we be better off letting our employees get health insurance in another way?’ And they’ve all done the math,” he said.
The CBO found in its assessment in March that “about 3 million to 5 million fewer people, on net, will obtain coverage through their employer each year from 2019 through 2022 than would have been the case under prior law.”
Holtz-Eakin said the fact that ACA creates subsidized insurance exchanges as a fallback may lead to the scenario of “employers never getting in the business of offering insurance so that over time it becomes acceptable to not offer it, and then employers begin dropping it. The bottom line is that it is profitable for both employees and employers to not offer insurance, so I expect norms to shift.”
Current CBO chief Doug Elmendorf pointed out on his blog that “there is clearly a tremendous amount of uncertainty about how employers and employees will respond to the set of opportunities and incentives under that legislation.”
But he also noted that ACA “creates new financial incentives for firms to offer and for many people to obtain health insurance coverage through their employers” – which may mean that conservatives’ fears are unwarranted or exaggerated.
But CBO did note in its March report that the penalties facing firms that don’t offer coverage “are much smaller than the costs of insurance; and not offering insurance allows firms to avoid some complexity and uncertainty.” Both those points support Holtz-Eakin’s forecast that many employers will drop coverage.
Yet the CBO report also notes that “employers may decide to keep offering coverage because they and their employees are accustomed to their doing so.” And defenders of the law say firms would run the risk of alienating their workers and damaging their ability to attract new employees if they stopped offering coverage, which is an attractive tax-free form of compensation for workers.
That tax-free status begins to end in 2018 when the ACA begins taxing high-cost, so-called “Cadillac” health insurance plans. But the tax on Cadillac plans is unpopular with labor unions so it’s possible congressional Democrats would seek to weaken or postpone it.
Conservative policy wonks say they don’t plan to offer all-encompassing systems and grand blueprints as an alternative to the president’s plan. After all, the very thing they reject in “Obamacare” is its command-and-control attempt to remake the U.S. health care sector. Grace-Marie Turner, president of the Galen Institute, said “To begin to change a $2.5 trillion health sector – one-sixth of our economy” would be to succumb to the same kind of overreaching that conservatives accused Democrats of when they passed the ACA.
“We don’t we have any better ideas of how to re-engineer that all at once than we what’ve seen” in the ACA, Turner said.
Sen. John Barrasso, R - Wyo., who, who practiced as an orthopedic surgeon before going to the Senate, said, “You’re not going to see a 2,700-page health care law coming from us. I just don’t think government does big things well. I’m much more interested in a step-by-step, common-sense approach….”
Barrasso has sponsored a State Health Care Choice Act that allows states to opt out of the individual mandate, the employer mandate and benefit mandates. States should innovate and devise with their own solutions, he said.