After reviewing what each candidate has been saying on the campaign trail, Kaiser Health News has published an article on how Obama and Romney might change the health law in the years ahead. The article is based on interviews with health policy experts, and can be found here.
President Barack Obama has asked voters to re-elect him so that he can put the law fully into effect. But some analysts predict the mounting pressures to reduce federal spending will complicate that plan. And others note that in a second term, Obama may be more open to working with Congress to tweak provisions of the law that have raised concerns. Leading up to this tight election, Obama and Democrats have been reluctant to make modifications to the law, known as the Affordable Care Act (ACA) or Obamacare.
Scale Back Subsidies: As part of that effort to reduce federal spending, there could be pressure to scale back the health law’s subsidies that help low-income residents afford coverage. People who earn up to 400 percent of poverty – currently about $92,000 for a family of four – are eligible to get financial help in purchasing coverage. Another big-ticket item is the expansion of Medicaid coverage to anyone up to 133 percent of the poverty level, or about $30,656 for a family of four.
Change in Age Rating Bands: The ACA prohibits insurers from charging more than three times as much for a policy sold to an older person than to a younger person. Some say this creates a problem where coverage become more affordable for the elderly but more expensive for the young people – an important demographic that needs to be able to get coverage.
Medical Device Tax Cut: Of the many taxes in the health law, one has come under strong criticism: a 2.3 percent tax on the sale of any taxable medical device. Medical device manufacturers have loudly opposed the tax and won some key congressional support. Legislation to repeal the tax passed the House in June with 37 Democrats joining Republicans to support the measure, although it is unlikely to receive Senate consideration this year.
Gov. Mitt Romney has promised a full-scale repeal of the ACA.. Short of Republicans controlling both chambers of Congress however, he would have to rely on the federal regulatory process to stop funding and give states wide latitude to implement – or ignore -- the law.
Slowing Down Implementation: The health law gives significant power to the secretary of Health and Human Services to implement the health law, and a Romney administration could use that power to slow the rulemaking process.
If Republicans win control of the Senate, they could also use the reconciliation process—which requires only a majority instead of the 60 votes usually needed to pass a measure -- to strip out sections of the law that relate to the federal budget. Reconciliation can be a cumbersome and difficult process, and it only applies to budget measures, so not all of the law would be subject to Reconciliation. And changes made under the process can’t increase the deficit.
Waivers: Romney has said he would allow states to opt-out of the health law by using a waiver process. He could also use the process to give states wide latitude to implement provisions, like health insurance exchanges, that differ from requirements in the ACA. But there are many rules that govern the waiver process, so there may be limitations on what the president could do through waivers.
If Romney opted not to move forward on the law, the administration could also be sued by individuals and groups. That litigation could take months – maybe years – to be resolved.
What Might Stay: Romney has said that he expects insurers to keep coverage that allows adult children to stay on a parent’s health insurance policy until age 26, although it’s unclear if he would support legislation or regulations to make that happen. He also has expressed support for states to set up health insurance exchanges and high-risk pools to cover the uninsured.