Whitehouse.govWhen the government shutdown began, Obamacare was
front and center. House Republicans wanted to defund the
health law—and said they wouldn’t vote for any continuing
resolution that kept funding in place.
But with President Obama and Democrats in the Senate determined
to protect the health care overhaul defunding the law through the
budget process, or even significantly rolling it back, was always
unlikely.
Still, reports from last night and this morning about an initial
offer made by the leadership of both parties in the Senate and a
likely
counteroffer made by House Republicans this morning indicate
that some health care tweaks may end up in a final deal.
A delay of Obamacare’s reinsurance fee:
Obamacare institutes a $63 per enrollee annual reinsurance fee for
the first three years the exchanges are in effect. The fees go into
a pool that essentially acts as a backstop for any insurer that
ends up attracting an unusually high percentage of sicker than
average people. The reinsurance fee is charged per head, not per
plan, so it makes family coverage more expensive. Big employers
like Delta don’t like it; the airline estimates that it will cost
the company $10 million next year. Labor unions don’t like it
either, because it adds to the cost of health coverage. The
proposal currently in play would not charge the fee next year, but
would still fund the insurer backstop in 2014 through an advance
from the Treasury,
according to Politico. That advance would then be paid
by an additional year of fees tacked on at the end.
A delay of Obamacare’s medical device tax: The
bill the House is reported to be moving on this morning would delay
the 2.3 percent excise tax on medical device manufacturers for two
years. That’s a partial win for the medical device lobby, which has
been pushing to kill the tax for a while. It’s also a provision
with bipartisan opposition: Last year, 18 Democratic Senators
signed a letter urging delay of the device tax. Most Obamacare
opponents are not big fans of the tax either. But privately some
have worried about attempts to repeal the tax entirely, as doing so
would remove a pressure point for Democratic legislators.
A requirement that members of Congress buy health
insurance on the exchanges without employer subsidies:
Obamacare was written with a requirement that members of Congress
and their staffers can only be offered coverage through the health
exchanges. Typically, those exchanges don’t allow individuals to
use tax-advantaged employer contributions to help pay for
insurance. But a rule issued earlier this year said that members of
Congress and their workers could use their existing employer
contributions. Reports suggest that this morning's House proposal
would reverse that rule for legislators, but not
staffers.
Enforcement of Obamacare’s income verification
provisions: This is an interesting one, because it doesn’t
really change Obamacare. Instead, it basically asks the
administration to enforce the law as it’s written—and certify that
it’s doing so. Some of the health law’s income verification
provisions were delayed over the summer, meaning that individuals
applying for insurance subsidies would essentially be relying on
the honor system. This addendum would require that the
administration actually verify the income of subsidy applicants and
that the Health and Human Services Secretary certify that the
administration was doing so. Some House Republicans have already
expressed concern about including this provision, because it treats
enforcement of a law as a concession—a potentially problematic
precedent.
Needless to say, all of this could change before a final deal is
made. Already there are signs that the White House, which would
also need to agree to any final deal, isn’t thrilled with this
morning’s House offer. But whatever happens, it’s unlikely that any
final agreement that moves through the Senate and the White House
will include larger-scale changes to the health law. If Obamacare
is going to be significantly altered, it won’t be through the
budget negotiation process.