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.
OBAMA'S CHALLENGES
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.
ROMNEY'S CHALLENGES
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.
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