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An Obamacare repeal?

August 11, 2015
by Bob Gatty
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When Congress gets back from its month-long August recess, look for a renewed battle over the Affordable Care Act (ACA), one that could result in provisions being included in federal budget legislation designed to repeal many of the healthcare law’s core provisions.

If that should that happen, President Obama undoubtedly will exercise his veto, forcing Republicans, who control both the House and Senate to remove those provisions so the budget bill can become law or fail in their promise to deliver a budget.

Earlier this month, Senate Majority Leader Mitch McConnell (R-KY) said GOP leaders intend to use a special legislative process called “reconciliation” to repeal at least a portion of the ACA.

“The entire law, we believe, based on discussions with the parliamentarian, is not reconcilable, but much of it is,” McConnell told reporters in an August 6 news conference.

McConnell and other Republicans who are determined to scuttle the ACA had hoped to use the reconciliation process to repeal the entire law. However, under the terms of the Congressional Budget Act of 1974, which created it, reconciliation allows for expedited consideration of certain tax, spending and debt limit legislation—but not language that does not affect revenue or spending.

Republicans, therefore, are challenged to write a reconciliation bill that would reduce the deficit, as required, since the Congressional Budget Office (CBO) estimates that full repeal would increase the deficit by $109 billion over the 2013–2022 period.

Under reconciliation, budget-related legislation can pass in the Senate with a simple majority rather than the usual 60 votes needed to break a filibuster.  However, acknowledging that Obama would most likely veto such a bill, McConnell replied, “It’s still important to us.”

Repeal, then what?

McConnell did not specify which provisions of the ACA would be targeted, but speculation is that provisions such as the mandates for individuals to be insured and employers to offer insurance would be strong candidates for elimination.

In March, the CBO projected that the law will reduce the number of people without coverage by 24 to 25 million over the next decade and that the program would cost $1.2 trillion during the next decade, or 11 percent less than earlier estimates.

Should Republicans succeed in somehow repealing the healthcare law, they would be forced to come up with a replacement, and in February, three top Republicans announced such a plan in advance of the Supreme Court’s decision that the law was constitutional.         

Under the plan, sponsored by Senate Finance Committee Chairman Orrin Hatch (R-UT), House Energy and Commerce Committee Chairman Fred Upton (R-MI) and Sen. Richard Burr (R-NC), individuals would not be required to buy health coverage and employers would not be required to provide it. Individuals with Medicaid coverage would be given tax credits to buy private plans, and upper-income families would no longer qualify for financial help.

The measure would return much of the healthcare regulatory power to states with certain federal baselines, such as capping healthcare taxes for employees. It would retain the ACA’s protections for people with preexisting conditions and the rule that allows young adults to remain on their parents’ plans until age 26.

Industry impact

The ACA, of course, expanded quality of care requirements for nursing homes that participate in Medicare and Medicaid and strengthens federal and state oversight and enforcement of quality of care violations. The ACA incorporates the Nursing Home Transparency and Improvement Act of 2009, which makes it easier for regulators to hold providers accountable for compliance with federal requirements.

The ACA also incorporates the Elder Justice Act and patient Safety and Abuse Prevention Act, which include provisions to protect long-term care recipients from abuse and other crimes.

The industry has been aggressively working to improve conditions and assure quality of care. For example, the American Health Care Association (AHCA) has developed its Quality Initiative, which is aligned with the Centers for Medicare & Medicaid Services (CMS)’ Quality Assurance/Performance Improvement (QAPI) program and federal mandates, such as Five-Star and the Improving Medicare Post-Acute Care Transformation (IMPACT) Act.          

Thus, much as been done to improve conditions and performance in the industry, partially as a result of the ACA, but also on the industry’s own initiative and to its credit.

Would a repeal of the ACA by Congress benefit the long-term care industry? Perhaps removing the employer mandate would be helpful to some companies, but what is the reality of that? With the shortage of qualified workers a serious problem for many organizations, would it make sense for companies in the healthcare industry to stop providing such coverage?

About politics

Most likely, those questions won’t need to be answered because it’s highly doubtful that Congress could override a certain Obama veto of any legislation that would repeal core components of the ACA.

So if it’s just another exercise in futility for Republicans, why did McConnell say the exercise is “still important to us”?

Did you see the first Republican presidential candidates’ debate Aug. 6? It’s all campaign rhetoric, pure and simple.