With Congress back in Washington, one of the first actions on health policy could be a budget reconciliation bill to unwind Obamacare. The move will be symbolic, since any such legislation heads right to the White House for a veto. But it will provide the GOP with an important political statement heading into an election year.
Several sources on and off Capitol Hill say the details of the bill are under discussion, but it would repeal targeted pieces of the Affordable Care Act, including the individual and employer mandates, the Independent Payment Advisory Board, the so-called “Cadillac tax,” and the medical device tax.
Sources say the bill may not include a repeal of the law’s insurance expansion. That’s may be because it would be politically problematic to take health insurance away from people who have obtained it under several years of Obamacare.
The reconciliation process allows Congress to send a bill to the president without a 60-vote threshold in the Senate, thus avoiding a Democratic filibuster. While the legislation has no chance of actually becoming law (it lacks the votes to override a veto), some of its provisions could have success as stand-alone bills.
Sen. Dean Heller (R-Nev.) plans to take his own smaller hack at the ACA by introducing legislation to repeal the “Cadillac tax,” which has garnered support from some Democrats in both chambers.
The “Cadillac tax” is a 40-percent excise tax on health plans with premiums exceeding $10,200 per person and $27,500 for families. Even though it does not take effect until 2018, it has been unpopular with business and labor groups. That has put Democrats in a difficult position. Many of them want a way to offset the cost of repealing the tax, which is projected to generate $87 billion over 10 years. President Obama would also likely veto that measure, meaning two-thirds of Congress would have to vote to override him.
The House Ways and Means Committee is already sitting on two separate bills to repeal the Cadillac tax. One, introduced by Rep. Joe Courtney (D-Conn.), is cosponsored by 118 Democrats and 14 Republicans. The other, by Rep. Frank Guinta (R-N.H.), has 81 Republican cosponsors.
Rep. Kevin Brady (R-Texas), health subcommittee chairman of the House Ways and Means Committee, is also working on a health care package that could include a repeal of the Cadillac tax and other individual health policy changes. The Ways and Means Committee is expected to mark up the package in the coming weeks.
Another Obamacare tax that could be on the chopping block this fall is the 2.3 percent medical device tax. A repeal bill already passed the House with bipartisan support in June, and the Senate could vote on a similar bill being written by Sens. Orrin Hatch (R-Utah) and Amy Klobuchar (D-Minn.).
One more change to the Affordable Care Act that has bipartisan support might get some buzz. It would allow states to choose whether to keep the small business insurance market from expanding to include firms with up to 100 employees. Right now, the small-group market only includes employers with up to 50 employees, but that is set to change next year. Businesses say the expansion could drag larger employers into a more expensive insurance market.
The bill, introduced by Reps. Brett Guthrie (R-Ky.) and Tony Cardenas (D-Calif.), has 168 Republican cosponsors and 39 Democratic cosponsors. Sen. Tim Scott (R-S.C.) has a parallel bill in the Senate that is cosponsored by 20 Republicans and 8 Democrats.
Aside from the Affordable Care Act, there is a push in Congress toward addressing mental health and reworking the Food and Drug Administration’s processes.
Over the August recess, the House Energy and Commerce Committee has been trying to fashion a mental health bill based on a measure by Rep. Tim Murphy (R-Pa.). As of several weeks ago, Democrats and Republicans still had some disagreements to address. In the Senate, Sens. Bill Cassidy (R-La.) and Chris Murphy (D-Conn.) recently unveiled a similar bill.
Meanwhile, the Senate Health, Education, Labor and Pensions Committee is drafting legislation to overhaul the Food and Drug Administration. The bill is a response to the 21st Century Cures Act that the House passed in June. The House bill would increase funding for the National Institutes of Health by $10 billion and expedite the approval of new drugs and medical devices. The Senate is not planning to take up the House bill. Instead, Senate HELP Chairman Lamar Alexander (R-Tenn.) wants his committee to release a draft of its own bill by the end of the year.
In the Senate Finance Committee, lawmakers are working on legislation to address Medicare patients that need chronic care. While the details are still in the works, ranking member Sen. Ron Wyden (D-Ore.) hopes to have the measure ready by the end of the year.