The Future of the Affordable Care Act: Uncertain, At Best

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Charles Dharapak / AP

Republican presidential candidate Mitt Romney speaks about the Supreme Court's health care ruling, Thursday, June 28, 2012, in Washington.

There are two health care-related sideshows playing out in Washington. One is a semantic argument about whether the fine for not having health insurance under Obamacare is a “penalty,” as the law’s author’s originally claimed, or a “tax,” as Supreme Court Chief Justice John Roberts ruled last month. The other is a House Republican attempt to immediately repeal the health care law, which is scheduled to get another vote this week. Neither of these debates has any consequence. In fact, they’re obscuring the real reasons the Affordable Care Act’s future is still incredibly uncertain, even after the High Court’s decision to uphold the law.

If Mitt Romney is elected President and Republicans emerge from this year’s elections with majorities in both houses of Congress, most experts agree that they could repeal huge swaths of the health care law via reconciliation, the parliamentary process that allowed Democrats to push health care reform over the finish line in 2010 without a supermajority in the Senate. As Politico reports (subscription required), GOP staffers on Capitol Hill are currently studying exactly what pieces of the law could be subject to change through reconciliation.

(MORE: Does Health Insurance Actually Make People Healthier?)

Congressional rules say the process can only be used for legislation that affects the federal budget and lowers the deficit, but that applies to much of the ACA. Subsidies created by the law to help low and middle-income Americans buy insurance outside of work could be vulnerable, for instance, even if Republicans can’t repeal the whole law, which the Congressional Budget Office says reduces the deficit. The loss of those subsidies could seriously imperil the affordability of insurance and the effort to pull currently uninsured Americans into the coverage market.

But even if Democrats hold onto their majority in the Senate, there’s no guarantee the law will remain untouched. Should Mitt Romney win the presidency, he could still cripple the health care law. A recent story in the New York Times about the Obama Administration’s efforts to undercut George W. Bush’s signature education law, No Child Left Behind, offers some insight. By granting waivers, the Times reports that the Obama Department of Education has allowed 26 states to escape NCLB’s controversial requirement that students meet testing standards in reading and math.

“The more waivers there are, the less there really is a law, right?” said Andy Porter, dean of the University of Pennsylvania’s Graduate School of Education.

(snip)

The waivers appear to follow an increasingly deliberate pattern by the administration to circumvent lawmakers, as it did last month when it granted hundreds of thousands of young illegal immigrants a reprieve from deportation. The administration has also unveiled policies to prevent drug shortages, raise fuel economy standards and cut refinancing fees for federally insured mortgages.

(MORE: Roberts Rules: What the Health Care Decision Means for the Country)

Predictably, congressional Republicans are crying foul over NCLB, accusing the Obama Administration of implementing its own policies instead of those outlined by the education law, which had broad bipartisan support when it passed the House and Senate in 2001. Still, you can be sure that a GOP presidential candidate vowing to “repeal” the health care law on “day one,” would do everything in his power to make good on his campaign promises.

The ACA may be particularly vulnerable under a Republican President due to its sheer complexity. Because the law has so many moving parts and affects so many constituencies, the ACA was written in a way that leaves many details up to the Department of Health and Human Services and its presidentially appointed head, who guides the rules-writing process. Such flexibility is often a good thing, says Gail Wilensky, a health care economist and former head of Medicaid and Medicare under George H.W. Bush. Flexible, vague statutes are more adaptable to changing circumstances. The downside, though, is that a lot is open to interpretation.

“When you write implementing regulations, you ought to think about it as a broad band,” says Wilensky. “At one end, you do the least you have to do in order to comply with the word of the statue. At the other end is the most that would be permissible without exceeding the authority given by the statute. In between those two points, there frequently is a wide span. In this case, it’s wider than normal. So much of the specific was not in the statute itself and that is what is going to make it vulnerable.”

(MORE: Decision 2012: Battle of the Health Care Contortionists)

The Obama Administration aims to have most of the major ACA regulations written by the end of the year. And it’s on target to reach that goal, according to Judy Solomon, vice president for health policy at the Center on Budget and Policy Priorities and an expert on federal health regulation. Solomon says regulations that are final or on track to be final by year’s end include designs for state health insurance exchanges, employer and individual mandates, and eligibility rules for Medicaid and new federal subsidies to help Americans afford coverage.

Yet, even regulations that Obama’s HHS finalizes can be re-written under a new Administration. “They can’t change the law unless they have the ability to pass a new law,” says Wilensky, referring to the ACA itself. “But you can change priorities. You can try to starve some activities. You can advise the (Centers for Medicare and Medicaid Services) administrator to focus elsewhere.” Although most of the spending called for in the ACA will happen without further action by Congress, some spending for ACA administrative functions is subject to congressional approval and could be vulnerable.

As for waivers like those the Obama Administration offered to states under No Child Left Behind, Solomon says there is not an exact parallel with the ACA. While the education law is a set of rules states must follow, the ACA also has many aspects that apply to individuals. Hundreds of billions of dollars in health insurance subsidies will still be distributed via federal tax credits. “This law makes individuals eligible for things,” says Solomon. A new administration can’t waive that eligibility.

(PHOTOS: The Rich History of Mitt Romney)

Democrats put a lot of political calculation into the ACA’s design and the timeline for putting it into effect. They delayed implementing most of the law until 2014 so the Congressional Budget Office, when measuring its budget impact in the 2012-2022 window, would find the ACA to be deficit reducing. (The law’s major costs don’t kick in until 2014.) In hindsight, this delay was a big gamble. Few Americans have yet been touched by the law, which has allowed critics to define it in the abstract. And the law’s most important implementation phase could come after Obama leaves the White House.

MORE: How the Supreme Court’s Medicaid Ruling Endangers Universal Coverage

122 comments
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Leftcoastrocky
Leftcoastrocky

Romney, should you become president, how do you propose that adults who are currently uninsured and who have preexisting conditions will obtain medical care/insurance?

Simple question.  Please answer

Leftcoastrocky
Leftcoastrocky

Romney, exactly what do you propose replacing it with?

How can the U.S. have any discussion on this issue if you refuse to disclose your policy.

And if you are either going to keep your policy secret or do not have one, why should we vote for you?

Richard Giles
Richard Giles

The deficit, government spending and “big government” haven’t caused our problems and constantly harping on them as if they did, is really a distraction, no doubt intentionally, from what did cause the problems.  To reduce government spending and the deficit are important goals but by themselves they won’t even address the negatives that did cause the hardships.  In every case our economic downturn was precipitated by run-away greed, gross dishonesty and self-indulgence where “the few” took advantage and created negative pressure on the very industries they depended on for their substantial gains.  Excessive deregulation, lax enforcement, little oversight and permissive policies provided the opportunities and that actually made the “puppet” politicians, who cater to “the money”, the responsible parties.  We have experienced the repeated crises in savings-and-loans, banks, dot.coms, manufacturing, the mortgage, financial, and investment industries as well as corporate corruption (like Enron) and industrywide failures (like the auto and financial industries), always with “the few” walking away with substantial profits and the costs being left to the majority.  

Calling those policies “conservative” is really a disguise for feeding the insatiable “more” (never enough) appetite of the 1% and is seeking to allow it to continue unabated.  It has drastically impacted our economy, and no doubt the worldwide economy, and those benefitting are making an all out effort with their mega-millions to con the people and manipulate public opinion in order to have their “puppet” politicians in power and to maintain their irrational advantage.  It is up to the voters, and they really don’t have to be “liberal”, just rational and objective to see through the subterfuge that is victimizing them and to firmly reject the “puppet” candidates, no matter how strong the propaganda is to do otherwise.  

survivor1962
survivor1962

Republicans may demonize this useful law all they want, but they still have nothing to offer as a replacement.  If they spent less time trying to destroy Obama's accomplishments and instead, do something constructive, like coming up with a replacement or ANYTHING that helps the poor and middle class of this country, maybe they wouldn't be seen as the party of negativity.  As it is, the entire party has nothing to offer the country as a whole...

boltusain
boltusain

my roomate's

step-sister made $21936 last week. she is making an income on the

computer and bought a $443100 house. All she did was get blessed and try

the instructions leaked on this site

http://LazyCash49.com

Alisaofs
Alisaofs

my buddy's

step-sister earned $13444 past month. she is making cash on the computer

and got a $367400 house. All she did was get fortunate and set to work

the steps exposed on this web site

http://LazyCash49.com

Leftcoastrocky
Leftcoastrocky

Romney pledged support for pushing tea party agenda in first 100 days, according to DeMint. 

Filips
Filips

what Pamela

said I didnt even know that some one can earn $7561 in four weeks on the

computer. have you seen this site http://www.LazyCash49.com

Parger
Parger

just as Lois

explained I am inspired that a person able to earn $9362 in one month

on the computer. did you read this site http://www.LazyCash49.com

radsenior
radsenior

These Tactical Egotistical Activist(TEA) hate Obama because the PPACA(Health Care Act) has already benefited the people in insurance coverage for children, extending insurance over pre-existing conditions and making insurance companies use 80 to 85 percent of monies collected for insureds rather than compensation for CEO' and CFO's.

And now the CBO says the renamed RomneyCare,  PPACA(Health Care Act), will save money. How outstanding is that? It is my contention that TEA-Republican's are astounded that Obama has accomplished so much in such a short period of time. From saving millions of jobs to ridding the world of Bin Ladin, Obama has numerous issues he has accomplished. People must take care in voting this November because TEA-Republicans are using the (R) when they really are (T).

Jackson
Jackson

my buddy's

ex-wife brought home $14754 last week. she is making money on the

internet and got a $491000 house. All she did was get lucky and apply

the clues made clear on this link

http://www.LazyCash49.com

jacksoncrew
jacksoncrew

my best

friend's sister-in-law got paid $19146 the prior month. she been making

cash on the internet and moved in a $433500 house. All she did was get

fortunate and apply the directions laid out on this website

http://www.LazyCash49.com

Swag
Swag

just as

Michelle answered I'm surprised that a student can earn $9893 in a few

weeks on the computer. did you read this link http://www.LazyCash49.com

James
James

what Marjorie answered I'm surprised that anybody can earn $5733 in a few

weeks on the computer. did you look at this website http://www.LazyCash49.com

radsenior
radsenior

RomneyCare, now called Obama Care, received the sanctioning from the highest court in the land, and TEA-Republican's still cannot accept it. Call TEA party operative what they are. Republicans are so scared of the TEA fringe, they will not disavow them as radicals and embrace their skewed notions and issues. Look at Texas where Dewhurst will not call Cruz a TEA party radical fanatic. But these radical fanatics back TEA party actions. TEA party extremes use the (R) instead of the (T) when running for office. It is my contention that TEA-Republican's are astounded that Obama has accomplished so much in such a short period of time. From saving millions of jobs to ridding the world of Bin Ladin, Obama has numerous issues he has accomplished. People must take care in voting this November because TEA-Republicans are using the (R) when they really are (T). The top dogs of the fringe showing up in Texas hoping for a killing of Dewhurst, who doesn't have the cajunas to call the TEA party extremes what they really are. The the PPACA(Health Care Act) has already benefited the people in insurance coverage for children, extending insurance over pre-existing conditions and making insurance companies use 80 to 85 percent of monies collected for insureds rather than compensation for CEO' and CFO's. And now the CBO says the renamed RomneyCare,  PPACA(Health Care Act), will save money. How outstanding is that? TEA-Republicans will stop at nothing to kill Obama's outstanding accomplishments. The truth is that Obama repeatedly cut taxes for such families, first through a tax credit in effect for 2009 and 2010, and beginning in 2011, through a reduction in the payroll tax that is worth $1,000 this year to workers earning $50,000 a year. And while it’s true that some tax increases contained in the new health care law would fall on individuals, they have mostly not taken effect yet and are small compared with the cuts the president already enacted. And this ad exaggerates them greatly. The ad — titled “Obama’s Promise” — lists several pledges that it claims the president has broken. The worst distortion it contains — one we haven’t addressed in this campaign — is an almost entirely groundless assertion that he broke his often-repeated promise not to raise taxes on persons making less than $200,000 a year, or couples making less than $250,000. The truth here is that Obama has lowered taxes for all workers through a 2 percentage point reduction in the Social Security payroll tax that started in 2011 and is scheduled to continue through the end of 2012. The cut is equal to $1,000 this year for a worker making $50,000 a year — or as much as $2,202 to any worker earning at least the maximum taxable level of wages or salary ($110,100 for 2012). America needs less confrontational TEA party extremist in office. The really funny part is Republican's are scared to cast out the TEA radical fringe.

Jardin J
Jardin J

Yes, but Replace it with what?

obamadrone81
obamadrone81

It is amazing how many people are willing to give up their rights and let government control their lives. Big mistake and a failure to understand history.

Leftcoastrocky
Leftcoastrocky

Yep, it is more fun to have unregulated insurance companies control our lives.

Richard_im_Himmel_bei_Gott
Richard_im_Himmel_bei_Gott

   Here's a thought: try taxing the christ-cult for all its holdings,

properties, etc., upon which it claims the right to be tax exempt -- at

the rate of $71,000,000,000 (yep, 71 TRILLION) dollars EACH YEAR.

What would Jeezus do?  He was a bit of a nutcase socialist, going around

giving healthcare away, absolutely free, to anyone who asked.

GOBAMA2012!!!!  YES WE DID!!!  YES WE CAN!!!   YES WE WILL!!!

Frank Griffin
Frank Griffin

since states failed you now thing a bigger government entity will somehow make this crap work.  I call your idea stay the course.  The republican ideas are the nw ideas.  Don't be such a lock step liberal and you will see that I am right.

Frank Griffin
Frank Griffin

This cin is out of her mind.  So a state government fails so that means an even bigger government entity must take a swing at it.  I would call that staying the course.  The republican ideas are the new ideas.  You are just too much of a lock step liberal to see it.

Susan Keller
Susan Keller

Why are we totally changing the way we handle healthcare for everyone when only a minority of people are uninsured and many of those by choice? It is the insanity of government at it's finest. That is similar to if you have 100 people and 16 have a noncommunicable disease, treating them all. It is a ploy to control another aspect of your life. Wow Medicare and Medicaid are going SO well, lets put everyone on it.

In 2010, the percentage of people

without health insurance, 16.3

percent, was not statistically

different from the rate in 2009.

The number of uninsured people

increased to 49.9 million in 2010

from 49.0 million in 2009 (Table 8 US Census Bureau.)

Richard Giles
Richard Giles

Romney doesn’t want to let the Bush Tax Cuts for the wealthy expire claiming that it is the wrong thing to do, that “raising taxes for the job creators is exactly what we don’t want to do”, once again clearly indicating their intention and priority to cater to “the money”, their strong supporters and controllers.  What he ignores is that first, the Bush Tax Cuts were always heavily overweighted in favor of the wealthy and second, if they actually did any good , they would have created jobs over the last twelve years.  Bush-Cheney used their offices and America’s resources to totally focus on benefiting “the few” and all they ever proved is that the “trickle down” theory is a complete fraud just making the wealthy wealthier and soliciting political support.  To continue with that irresponsible, rationalized mentality is to ignore reality and the appropriateness and need to now raise taxes on the wealthy - it is what a responsible government would do.

gorak
gorak

The conference bill, which is the one signed by the president, was passed by reconciliation. If the entire bill as signed by the president can be passed by reconciliation, it can also be repealed in the same way. 

FreedomRings_CA
FreedomRings_CA

". . .even if Republicans can’t repeal the whole law, which the Congressional Budget Office says reduces the deficit."

Your disingenuous citing of "facts" reeks of deception to your readers, Ms. Pickert.

The CBO found that PPACA reduced the deficit when they did their analysis of the Law in early 2010, going out 10 years (which is their normal limit on forecasting).  Since the costs the government will incur under the program do not begin to take affect until Jan 2014, using years 2010 to 2013 (the first 4 years of the 10-year increment CBO is permitted to project) , there was no additional cost to the Federal budget for the Law and so it came out as a "reduction" in the deficit.

In early 2012, CBO - after the Medicare Actuary issued a report on the fiscal health of that program (not good, by the way) - did the same analysis they had done in 2010 on PPACA, but now going out from 2012 to 2022.  Surprise!  CBO determined PPACA will ADD to the deficit by approximately 500 billion dollars over that 10-year time period.PPACA increases the deficit - And that's with the Law only fully implemented for 8 years ! How much will the ACTUAL COST be once the Law is fully implemented over a ten-year period? We don't know - but we already know the cost is HIGHER and the supposed "deficit reduction" does not, in fact, exist.

Why am I not surprised that Obama and the Democrats neglected to mention that little fact?  And why am I not surprised you failed to mention to your readers either the actual facts themselves regarding the real cost of PPACA or that you failed to mention the fact the Democrats were claiming as fact something that is pure fiction?

  Deceitful.

paulejb
paulejb

jason024,

"If they refuse to pay....it is just like not paying your taxes or other government fines...you get a warning, larger fine, wage garnishment, and finally jail time."

-------------------------------------------

Fascinating! Can you site the section and page number of the ACA that stipulates jail time?

obamunist_party
obamunist_party

This has been a Democrat obsession for nearly a century, so they are not going to give up - ever.  Which means that if we want to be free, we are going to have to fight, and not just  at the ballot box .  Democrats have established the rules of engagement - there are no rules.    So whatever it takes to eradicate totalitarian socialism is fair game.   The first order of business is to find a political party that will do whatever it takes to eradicate totalitarian socialism, and then get rid of the GOP, which is the biggest obstacle in the way of destroying totalitarian socialism.  Next, the money pipeline to the  government needs to be shut down.   

FreedomRings_CA
FreedomRings_CA

 So it looks like the only way to get the Democrats to shut up on the subject of health care is to FIX THE PROBLEMS WITH THE SYSTEM -- using a free market approach.  BUT FIX THEM!!!!!!!!

Instead, the Republican Party has sat on its hands and DONE NOTHING to solve the problems in our health care system. 

They are as much to blame for 'ObummerCare' as the Democrats.

tpaine1
tpaine1

The ObamaCare Tax is either dead with a GOP Congress and President or it's dead because we will be in the middle of the second Great Depression and soup lines. 

I realize Democrats think this is just laughable, but I can assure you, my business cannot withstand another four years of Obama.  We will simply throw in the towel and accept the wisdom of the American public that there really is a "free lunch" and the Tooth Fairy.

alvinjh
alvinjh

Why work and sacrifice? Sign up for 'free' stuff-- like Matthew Lesko says... gobs and gobs of free stuff the book says...  even MORE now! Why would anyone choose to be vilified, castigated and reviled for doing business, paying bills and employing people in an ever  increasingly more difficult regulatory environment where you are told what you can't do and what you must do by people who've never done anything but work for government?

Honestly, time to quit and join the party. Get your free stuff.  It's 'fun'!

It's like the lady said when Obama was elected--no need to ever worry about buying food or paying the rent. Obama is in office now...

"Obama Is Going To Pay For My Gas And Mortgage!!! "

http://www.youtube.com/watch?v...