President Barack Obama’s health-care plan will face a fresh round of investigations and public hearings in the Republican-controlled Senate next year, though the president’s veto power will keep it from being dismantled.
Senate committees with jurisdiction over health issues will ramp up oversight of the Affordable Care Act, said David Cleary, Republican staff director for the Health, Education, Labor and Pensions Committee.
Little else with the law is likely to change before a new president takes office in 2017. Health-care companies including device maker Medtronic Inc. (MDT:US) and insurer WellPoint Inc. (WLP:US) want Republicans to repeal new taxes in the health law; hospitals would like a cost-control board to be repealed; employers are seeking relief from the requirement that they provide insurance.
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“There are pieces of it that are extremely unpopular with the American public that the Senate ought to have a chance to vote on,” Senator Mitch McConnell, the Kentucky Republican who won re-election and is in line to become majority leader, said on Fox News on Oct. 28.
The law, intended to provide coverage to tens of millions of uninsured Americans, has been attacked by Republicans since Congress passed it on party-line votes in 2010. While many provisions are popular, a majority of Americans say they disapprove of it, polls show.
50 Times
The Republican-led U.S. House has voted more than 50 times to repeal or delay all or part of the Affordable Care Act.
McConnell said on Fox he wants the Senate to vote on “repealing the medical-device tax, trying to restore the 40-hour workweek, voting on whether or not we should continue the individual mandate, which people hate, detest and despise.” Republicans propose letting employers stop providing insurance for people working fewer than 40 hours a week, instead of the current 30 hours.
Any of those changes would require agreement from at least some Senate Democrats and Obama’s signature. And while some Democrats back a medical-device tax repeal, McConnell said Republicans won’t have the votes to go further and dismantle the law.
“No one thinks we’re going to get that,” he said. A two-thirds vote of both chambers is required to override a presidential veto.
Budget Procedure
A Republican Congress may be able to send a bill repealing much of Obamacare to the president’s desk. Senate Republicans could use a budget procedure known as reconciliation that would allow the measure to advance with 51 votes, rather than 60, to keep the Democratic minority from blocking it.
The tactic carries risk: More than 10 million people have so far gained insurance coverage under the health law, and some Senate Republicans up for re-election in 2016 may want to avoid voting against a law benefiting many of their constituents.
Republicans said no strategy on the budget has been decided.
“It’s improbable that any change would take place to the superstructure of the legislation,” Chip Kahn, president of the Federation of American Hospitals, said in a telephone interview. His group represents for-profit hospitals.
Campaign contributions from health-care interests have favored Republicans by more than $8 million, according to data compiled by the Center for Responsive Politics.
That suggests doctors, hospitals, insurers and drug companies see an advantage in the party controlling all of Congress, said Dan Mendelson, president of Avalere Health, a consulting firm in Washington.
‘Less Friction’
“There’s less friction when the two houses are aligned,” Mendelson said.
Among health-care issues unrelated to Obamacare, a Republican Congress may seek to repeal a budget formula that has dictated annual cuts in Medicare payments to physicians for more than a decade. Congress has reversed the cut every year since 2002, although physicians have received only nominal increases in their reimbursement.
Earlier this year, both parties in the House and Senate agreed to replace the Medicare formula, though legislation didn’t advance because of disputes over how to pay the cost, estimated at more than $140 billion over a decade.
In October, Obama signed bipartisan legislation aimed at improving care for people discharged from hospitals. Kahn said that may signal future agreement on below-the-radar health-care issues including a House effort to overhaul the way drugs are developed and approved, called “21st Century Cures.”
‘Real Action’
“In health care, the only way we’re going to see real action is through items where consensus can be drawn,” Kahn said. “That doesn’t mean there won’t be a lot of noise and discussions about changes in Obamacare, but I think those will be very limited by whatever the president will sign.”
Mendelson said there’s an outside possibility that Republicans in control of the Senate may soften their strident opposition to the health law and discuss changes with the Obama administration.
He said Obama might agree to repeal the medical-device tax in exchange for a revision to remove the chance that the Supreme Court may strip subsidies from millions of Americans living in states served by federal insurance exchanges.
“That’s the kind of thing the administration would really love to fix,” Mendelson said. “There could be some kind of quid pro quo discussions, in a more collaborative venue, to clean up some aspects of the bill that need to be cleaned up and make some concessions to make it better” for Republicans.