GOP Likely To Propose Health Reforms, ACA Repeal in Budget

Senior House aides this week said House Republicans intend to pass a budget next year that overhauls both Medicare and Medicaid and repeals the Affordable Care Act, the New York Times reports.

Specifically, House GOP officials said the chamber likely will pass a budget plan similar to the ones drafted by House Budget Committee Chair Paul Ryan (R-Wis.). Ryan's plans passed in the House three times on party lines since 2011 but did not gain traction in the Democrat-controlled Senate (Weisman, New York Times, 11/12).

The 2015 budget plan would curb government spending by about $5 trillion over the next decade, in part by privatizing Medicare and repealing the ACA. Among its proposals, the budget blueprint would:

• Cut $129 billion from Medicare over the next decade by converting the program into a premium-support system starting in 2024;
• Maintain the ACA's $716 billion in Medicare savings over the next 10 years;
• Save $732 billion in Medicaid spending over 10 years by consolidating Medicaid and CHIP into one program and converting Medicaid into a block-grant system, under which each state would receive a set amount from the federal government to provide coverage for low-income residents; and
• Repeal nearly all of the ACA, including the politically unpopular Independent Payment Advisory Board, Medicaid expansion, and all of the law's taxes and premium subsidies designed to offset the price of purchasing private coverage via the law's insurance exchanges (California Healthline, 4/2).

Sen. Ron Johnson (R-Wis.), who serves on the Senate Budget Committee, said that members of both chambers who deal with the budget would "try and coordinate as much as possible" and "hew to some basic principles," such as passing a balanced budget for the first time in a decade. In addition, incoming Senate Budget Committee Chair Jeff Sessions (R-Ala.) has supported Ryan's budget plans in the past.

However, Sen. Patrick Toomey (R-Pa.), another member of the Senate Budget Committee, noted that President Obama likely would veto such a plan (New York Times, 11/12).

Senate Republicans Differ on ACA Repeal Approach

Meanwhile, some GOP senators have expressed support for using a budget reconciliation process to repeal the ACA, Politico reports (Nather, Politico, 11/11).

Various conservative groups are pushing for Congress to fully repeal the ACA through a legislative process known as budget reconciliation, which allows budget bills to be passed by a simple majority of 51 votes. Doing so would avoid Democratic hurdles that Republicans would typically need 60 votes to bypass. However, Congress would need to pass a budget resolution in order to complete the reconciliation process, which could be difficult (Haberkorn, Politico, 11/5).

According to Politico, Sen. Ted Cruz (R-Texas) has joined calls to use reconciliation to pass such a repeal, despite concerns from other Republicans that repealing the entire law through the reconciliation process might not be the best tactic. Instead, some GOP members are calling for smaller changes that would dismantle the ACA piece-by-piece.

Senate Republicans likely will discuss their plans to address the law during a policy lunch on Thursday, according to Politico (Politico, 11/11).

Former White House Adviser Suggests Employer Mandate Compromise

In related news, former White House adviser David Axelrod on Tuesday said the Obama administration should compromise with Republicans on the employer mandate's definition of full-time employees under the ACA, The Hill's "Briefing Room" reports (Sullivan, "Briefing Room," The Hill, 11/11).

The employer mandate requires businesses with more than 50 full-time employees working 30 hours or more per week to provide affordable health insurance coverage to workers or face fines.

Under a timeline released by the Department of Treasury and Internal Revenue Service in February, mid-sized businesses that employ 50 to 99 full-time workers will have another year to provide health insurance coverage to employees. These employers will not face fines for failing to provide coverage to workers until 2016, according to the final rule.

Meanwhile, businesses that employ 100 or more full-time workers will be subject to the mandate starting in 2015. However, the final rule gives these employers more time to ramp up coverage. To avoid fines, large employers only need to offer coverage to 70% of workers in 2015, rather than 95%. They will need to start offering coverage to 95% of workers in 2016 (California Healthline, 7/25).

Axelrod during an MSNBC interview Tuesday said "the key is to say, 'Are there areas in which they can work?'" He added, "Is it, you know, the number of hours from 30 to 40 in terms of how people are categorized for the program and what businesses have to do, whether a 30-hour week is enough to qualify for the program or whether you need more hours, those are things they ought to be able to compromise on."

According to "Briefing Room," House Speaker John Boehner (R-Ohio) and McConnell in an opinion piece  for the Wall Street Journal last week wrote that changing the employer mandate will be among their top priorities for altering the ACA ("Briefing Room," The Hill, 11/11).