A Tale of Two Campaigns: Repeal vs. Reinforce

Health reform won’t be repealed this year.

A range of policy experts and politicians — like Gail Wilensky, who in the early 1990s headed HCFA, now known as CMS, and Sen. Tom Coburn (R-Okla.) — have tacitly acknowledged as much in recent weeks. While the Republicans’ push to overturn the law has gained steam, the effort faces considerable hurdles. President Obama likely will retain veto power after the midterm elections; the law’s $143 billion in projected savings across 10 years would need to be offset by new legislation; and provisions that the GOP supports are interwoven with the ones it opposes. Moreover, the GOP cannot agree on what would replace the law were it to disappear tomorrow.

As a result, congressional Republicans are mounting a strategy to “chip” at the overhaul’s funding and capitalize on grassroots enthusiasm to sway reluctant Democrats to their side.

At the same time, Democrats are stepping up their own campaign to promote health reform’s benefits as new provisions take effect. Both efforts are coming to a head as the political season heats up.

GOP ‘Nibbles Around Edges’

There is some similarity to how both parties have approached the task of enacting, or weakening, the sweeping legislation: using the back door.

Six months ago, Democrats realized that they didn’t have the votes to pass the health reform overhaul, so party leaders turned to a budgetary tactic to complete their effort.

Republicans now are confronting a similar reality: they probably won’t win enough seats this fall to have veto-proof majorities, but they can target the overhaul’s funding. The party is now “zeroing in on a nibble-around-the-edges strategy” to weaken the law, Politico notes.

As one starting point, Republicans have tried to eliminate a new tax-reporting mandate for businesses that would generate $17 billion over 10 years. Although the measure has bipartisan support — with seven Democratic senators joining 39 Republicans in a vote last week — efforts have stalled over a lack of funding offsets and Democrats’ competing proposal.

GOP leaders also are eying funds directed for the Internal Revenue Service, which could need at least $5 billion to hire additional staff to enforce the new mandates under reform. Republicans may seek to attach a rider into an appropriations bill that would prohibit federal workers from performing various tasks necessary to implementing the law.

At the same time, the GOP is working to spotlight aspects of the law that it finds most objectionable. Republican senators this week requested CMS administrator Donald Berwick attend a forum on the overhaul’s rollout and have pushed HHS Secretary Kathleen Sebelius to explain how the reform law affects insurance premiums. Grace Turner of the Galen Institute also encouraged Republicans to use the power of the Congressional Review Act to “review the avalanche of new regulations … and to shine a light on the most egregious ones.”

Democrats Try To Bolster Case Yet Again

Meanwhile, Democrats are using the law’s six-month anniversary — and a slate of new provisions that affect health insurance scheduled to take effect on Thursday — as a platform to tout the overhaul’s benefits. The new provisions, as laid out by California Healthline‘s Capitol Desk, include expanded coverage for children with pre-existing conditions and a lifting of lifetime caps on health benefits.

As part of this week’s push, Sebelius told a conference on Monday that the law will help stabilize the U.S. health market. She noted that around 2,000 employers and unions are now benefitting from an overhaul provision that helps cover medical expenses for those in corporate or union retiree health plans.  Obama on Wednesday also will promote the so-called Patients’ Bill of Rights, a White House blueprint of insurance reforms that take effect on Thursday.

The efforts come with the public still critical of the overhaul , six weeks ahead of the midterm elections. A recent CBS News/New York Times survey found that 37% of respondents approved of the health care law, compared with 49% who said they disapproved of the law. However, 41% of respondents to the survey said that a candidate’s stance on the health reform law would “not make much difference” in how they vote.

Some Democrats are taking a longer-term view on reform’s implementation and public popularity. Even if a Republican president took office in 2013, they note that many of the reform law’s measures already would be enacted and the biggest reforms would only be one year away, complicating efforts to reverse the momentum of health reform.

As Republicans and Democrats continue their efforts, here’s a look at other reform news.

Promoting the Reform Law

  • On Thursday, President Obama is scheduled to deliver a speech to mark the six-month anniversary of the federal health reform law (Adamy/Meckler, Wall Street Journal, 9/19). On Wednesday night, Obama will promote the so-called Patients’ Bill of Rights, a White House blueprint of insurance reforms scheduled to take effect on Thursday, including the elimination of copayments for preventive care services, a ban on coverage denials for children with pre-existing medical conditions and a prohibition against policy rescissions (Haberkorn/Kliff, “Pulse,” Politico, 9/20).
  • The Obama administration and a coalition of groups that supported the federal health reform law are planning campaigns to extol benefits of the overhaul slated to take effect this month. Some of the groups that will be participating in the publicity campaigns include the Health Information Center, U.S. Public Interest Research Group and Families USA (Haberkorn/Kliff, Politico, 9/15).
  • Under the federal health reform law, nearly 29 million U.S. residents will be eligible for a tax credit for purchasing health insurance that is scheduled to take effect in 2014, according to a new report from Families USA. The group, which supports the health reform law, noted that the total value of the tax credits in 2014 will be $110 billion (Abelson, “Prescriptions,” New York Times, 9/14).

On the Hill

  • Last week, Rep. Gene Taylor (D-Miss.) became the first Democrat to sign a petition calling for a vote on legislation (HR 4972) that would repeal the federal health reform law. The petition needs 218 signatures to bring the bill out of committee and onto the House floor. Taylor is the 172nd person to sign it. A spokesperson for Taylor provided no comment on why he signed the petition (Sherman, Politico, 9/15).
  • Democrats on the House Energy and Commerce Committee are considering a new proposal to repeal a provision in the federal health reform law that would mandate additional tax-reporting requirements for small businesses, just days after the Senate rejected a pair of proposals that would have scaled back or completely repealed the mandate. Lawmakers seeking to repeal the provision have yet to reach an agreement on how to recoup the $17 billion in revenue that the tax-reporting mandate is expected to generate (Haberkorn, Politico, 9/16).
  • Last week, House Energy and Commerce Committee Chair Henry Waxman (D-Calif.) warned health insurance companies that the federal government will scrutinize their operation and spending of Medicaid managed care plans, which will be expanded under the federal health reform law. Under the overhaul, state Medicaid programs by 2014 will be required to cover people in households whose annual incomes are up to 133% of the federal poverty level, or $14,400 (Norman, CQ HealthBeat, 9/16).
  • Republicans are attempting to repeal the health care reform law by eliminating funding for various measures, but the party is still at odds over how to replace the overhaul. Some Republican lawmakers have argued in favor of enacting a GOP health plan that was rejected by the House in 2009. Other GOP lawmakers support a proposal by Sen. Tom Coburn (R-Okla.) and Rep. Paul Ryan (R-Wis.) that would replace Medicaid with private insurance for most low-income people and convert Medicare into a voucher system (Alonso-Zaldivar, AP/Washington Post, 9/19).

Rolling Out New Grants

  • Last week, HHS awarded grants totaling $31 million to nine states for prevention and wellness programs to reduce obesity and smoking, increase physical activity and boost nutrition. As part of the grant awards, the Santa Clara County Public Health Department received $3.6 million for obesity prevention efforts. Funding for the grants was included in the federal health reform law (Pecquet, “Healthwatch,” The Hill, 9/14).
  • On Monday, CDC announced $42.5 million in grants to fund 94 new projects designed to strengthen local public health services. Funding for the grants comes from the Prevention and Public Health Fund established under the federal health reform law. As part of the awards, the California Department of Public Health received $2,060,128 (McKinney, Modern Healthcare, 9/21).

Analyzing the Overhaul

  • The individual health insurance mandate in the health reform law does not violate the Constitution, according to an analysis published recently in the Hastings Center Report. In the analysis, Lawrence Gostin, professor of global health law at Georgetown University Law Center, wrote that health care qualifies as part of interstate commerce because it involves various products moving across state lines, such as pharmaceuticals, medical equipment, insurance claims and providers (Frieden, MedPageToday, 9/15).
  • A provision in the federal health reform law that will provide a 50% discount on brand-name prescription medications to Medicare beneficiaries who reach the so-called “doughnut hole” in prescription drug coverage might be offset by higher drug prices. Officials at the Center for Medicare Advocacy and the Medicare Rights Center recently sent a letter to CMS stating that there is “legitimate concern that some manufacturers will steeply increase the price of drugs in order to offset the cost of the discount to the manufacturers at the expense of both consumers and the Medicare program itself” (Hilzenrath, Washington Post, 9/20).

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