With big wins in the Senate, House, and governors’ races, the GOP is poised to push its policies – here’s a brief review of potential moves. For the next two years the GOP will be in charge of Congress where it can do a lot to hamstring PPACA via budgeting procedures and incremental changes. Then, GOP candidates can point to the failure of PPACA as proof of the incompetence of Dems.
First, let’s not jump to the conclusion that this race was all about “Obamacare”. Polls indicate ACA and implementation thereof was a secondary issue - if that - in almost every race.
Second, the next two years will be mostly political positioning in preparation for the 2016 election. Republicans will seek to show Democrats are “the party of no”, offering up a plethora of bills for President Obama’s veto. Dems will lick their wounds and take heart in the favorable Senate electoral landscape, which is pretty much the opposite of this year’s. Whether that will remain the case two years’ hence remains to be seen.
Changes to ACA -
There will almost certainly be yet another effort on the part of the House to repeal PPACA, and the Senate will likely go along – subject to a filibuster. That will be political theater, laying the groundwork for incremental moves.
Expect an early effort to dramatically alter, if not repeal, the mandate for employers with more than 50 workers. It has been delayed already, is anathema to conservatives, and if combined with other “fixes” may force a signature.
There may also be a movement to overturn the individual mandate; this will also be veto’ed.
Copper plan – some have advanced the idea of a cheapo health plan that would cover about half of an insured’s medical costs. While this doesn’t make much sense, it does have the backing of a couple Democrats in the Senate which may be enough to get it past the filibuster hurdle
The risk management program (the “3 Rs”) program that shifts ‘excess’ profits from insurers with low claims to help insurers with high claims costs cover their expenses (full explanation here) is particularly distasteful to conservatives who want insurers to rise or fail on their own. It is scheduled to expire at the end of 2016; expect the GOP to push to end it sooner. That said, the insurance industry and their allies will push very, very hard to keep the 3Rs in place.
The much-despised medical device tax will face repeal; not for good policy reasons but because the device industry is loaded with cash and spends it lavishly on lobbyists and politicians. Washington at its best…
There’s a push to release more data on outcomes and pricing so consumers have a better idea what treatment costs and who has what outcomes. Don’t expect this to get very far; for some good, and some not-so-good reasons, physicians don’t want this information out there – primarily because some will look bad.
Medicaid expansion – there’s likely going to be more resistance to expanding Medicaid due largely to the extent of the Republican wins. Kansas and Maine would have added coverage if the Dems had won; there would have been more support in other states as well. The broad-based wins by conservatives will push expansion off the agenda – at least until the next election.
What does this mean for you?
Washington is dysfunctional now, and will be much worse.
For investors, insurers, and employers, even more uncertainty about the future of health care. Just what we need.