The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Moving Beyond Health Care Reform Repeal to Revision

Posted by Alan on January 27, 2011

During the 2010 election Republicans promised to “Repeal and Replace” the Patient Protection and Affordable Care Act. Having gained a majority in the House of Representatives they quickly passed a bill to do just that (joined by three Democrats). Having failed to gain a majority in the Senate the repeal process is all but over.

Senate Majority Leader Harry Reid has said he would not bring the “Repealing the Job-Killing Health Care Law Act”to the Senate floor for a vote. In response Republican Senators have promised to offer amendments repealing what they see as unpopular provisions of the law. In both the House and Senate GOP lawmakers are targeting the PPACA’s requirement that all Americans obtain health insurance coverage, malpractice reform, taxes imposed on health insurance carriers and others, denying federal subsidies (including tax deductions) for health plans that cover abortions, and permit the sale of health insurance across state lines. While Republicans know these amendments will fail, forcing Democrats up for election in 2012 to cast several votes defending President Barack Obama’s health care legislation has significant potential political benefits.

But two can play this game. So if Republicans force a vote on their measures, Democrats will require GOP Senators to vote on legislation concerning more popular elements of the PPACA. These include closing the Medicare prescription benefit donut hole, eliminating pre-existing condition exclusions for children, and allowing children to remain on their parent’s health plan up to age 26.

Then there’s the coming Republican effort to defund the PPACA. (Which creates an enjoyably ironic situation. Many in both parties, but especially Republicans, argued Democrats were arrogant to pass health care reform in the face of polls showing the public opposed their legislation. How will they respond to a Kaiser Family Foundation and Harvard School of Public Health showing 62 percent of respondents opposed cutting off funds needed to implement the PPACA?)

What all this means is that we’re in for two years of political showmanship concerning health care reform. But that doesn’t mean meaningful changes to PPACA won’t be forthcoming. President Obama declared his willingness to sign a medical malpractice reform bill. Of course there’s tort reform and then there’s tort reform. Health and Human Services Secretary Kathleen Sebelius has committed to providing “what the parameters of medical malpractice reform might be” during a hearing of the Senate Health, Education, Labor and Pensions Committee Hearing. Whether there is enough common grounds with GOP proposals to deal with medical malpractice remains uncertain until then. Meanwhile, 60 Senators have signed onto a bill to repeal the the 1099 reporting provisions contained in the health care reform law. Down the road there will be efforts to gain bi-partisan support for changes to more difficult provisions of the new reform law, including medical loss ratio requirements and the exchanges.

Yes we’ll all be subjected to the sound and fury signifying only political posturing and one-upmanship. But there will also be acts of quiet negotiation aimed at what President Obama in his State of the Union speech called “improving” the Patient Protection and Affordable Care Act. And as Politico Post describes the reaction of this language by Julie Barnes, director of health policy at the Bipartisan Policy Center, this could well be “a signal that bipartisan cooperation on health reform tweaks is on the horizon.”

One can only hope.


3 Responses to “Moving Beyond Health Care Reform Repeal to Revision”

  1. Thanks Alan. Did you ever find out if the breakout committee met to discuss the agents commissions in the MLR?

    • Alan said

      What I’ve been able to find out is that the committee met, made several recommendations to HHS. The broker commission was just one issue they addressed (another would have provided for a uniform transition period for phasing in the medical loss ratio rules. Unfortunately, none of the recommendations were not accepted by HHS. To put it politely, this angered many of the state commissioners. As a result the commissioners, and NAHU, have shifted their focus to Congress. Meanwhile Secretary Sebelius reached out to a few commissioners and indicated their recommendations weren’t off the table yet. Discussions are supposed to continue. Meanwhile, I’ve been told that while the NAIC will continue discussions with HHS, they are not counting on relief from the Department. So they are pulling together formal recommendations to Congress for relief.

      NAHU, NAIFA and the Big I continue to lobby the issue as well. They are framing the commission pass-through concept as a jobs and consumer protection issue, which is appropriate and accurate. The legislative process is a long one, so we’ll have to wait to see if changes are forthcoming. In the meantime, while hoping otherwise, carriers and everyone else are assuming the existing interpretation of the MLR provision will be the final version.

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