GOP Bills Hacking at Healthcare Reform 'Branch by Branch'

February 02, 2011

February 2, 2011 — One day after a federal judge declared the Affordable Care Act (ACA) unconstitutional because of its individual mandate to obtain health insurance coverage, Republican senators unveiled a bill that would let states opt out of that provision and several others that are equally controversial.

The legislation is one more example of how Congressional Republicans are waging war against the new healthcare reform law. In addition to attempting to repeal it in one fell swoop, they are attacking it on a piecemeal basis with a flurry of potentially crippling bills.

Rep. David Camp (R-MI), chair of the powerful House Ways and Means committee, recently described the GOP strategy to reporters in terms of arboriculture. If Republicans cannot cut down the "rotten" tree represented by the ACA, Camp said, "we'll prune it branch by branch."

Yet another GOP bill would figuratively shut off the tree's water supply by not spending any federal dollars to implement the ACA.

Given the Republican majority in the House, all the anti-ACA bills originating there are almost guaranteed passage. However, they face the same likely dead end as the recently passed House Republican bill to repeal the ACA. The Senate is still controlled by Democrats, who have vowed to oppose any measure that undermines the ACA. A second line of defense is President Barack Obama, who can veto attacks on his signature legislation.

Roadblocking the Individual Mandate

One of the chief targets of anti-ACA legislation introduced by Congressional Republicans is the individual mandate, which requires people to obtain health insurance coverage beginning in 2014 or else pay a penalty. Sen. Orrin Hatch (R-UT) has introduced a bill that would repeal the individual mandate outright. Hatch and other Republicans call the mandate an unconstitutional intrusion of the federal government into the lives of American citizens.

Sharing that view is US District Judge Roger Vinson in Pensacola, Florida, who on January 31 declared the entire ACA unconstitutional. Another federal judge also has voided the individual mandate while preserving the rest of the law. Two other federal judges have upheld the mandate's soundness.

On Tuesday, Sen. John Barrasso, MD (R-WY), and Sen. Lindsey Graham (R-SC) introduced a bill called The State Health Care Choice Act, which permits individual states to opt out of the individual mandate and 3 other ACA provisions:

  • a penalty that large employers must pay if they do not offer affordable coverage to employees, assuming that at least one of those employees then receives a tax credit to purchase it on his or her own through an insurance exchange;

  • the expansion of eligibility requirements for state Medicaid programs — many state officials say that their already strained budgets cannot endure a wave of new Medicaid beneficiaries; and

  • federal standards for health insurance benefits, and requirements for regulating insurers.

"Instead of requiring states to follow ObamaCare's one-size-fits-all policy, our bill lets states decide what works best for them," Dr. Barrasso, an orthopaedic surgeon, said in a press release.

Last week, Rep. Cathy McMorris Rodgers (R-WA) introduced another bill that would cripple the individual mandate by forbidding the Department of Treasury from hiring any employees to enforce it — specifically, to collect penalties from people who lack coverage. The penalty is the greater of a flat-dollar amount or a percentage of taxable income. The flat-dollar amount is $95 in 2014, $325 in 2015, and $695 in 2015, with the penalty indexed to inflation afterward. The corresponding income percentages are 1%, 2%, and 2.5%.

The Internal Revenue Service will have the job of both determining whether a person has coverage and, for those lacking it, collecting the penalty in the form of a tax.

EHR Meaningful-Use Funds Also Threatened

The Republican campaign against the ACA extends beyond coverage issues. A Senate bill cosponsored by Hatch would eliminate a tax on medical devices designed to generate $20 billion over 10 years. Hatch's bill does not call for offsetting the loss of this revenue with either new revenue from other sources or reductions elsewhere in the federal budget — an antideficit practice that Congressional Republicans have insisted on with Democratic legislation.

Yet another bill, from Rep. Phil Roe, MD (R-TN), would erase an ACA-created agency that will advise Congress on how to control Medicare spending. Congressional Republicans as well as organized medicine fear that the new agency, called the Independent Payment Advisory Board (IPAB), will wield too much power with too little accountability to lawmakers. Dr. Roe, an obstetrician-gynecologist, said in a press release that he worries that the IPAB will harm patient care in its pursuit of trimming healthcare costs. His bill makes no provision for offsetting the estimated $28 billion that the IPAB is supposed to save the federal government through 2019.

The entire ACA is consigned to defunding under a bill introduced simultaneously in both the House and Senate that seeks to reduce federal spending by $2.5 trillion through fiscal 2021. The measure forbids appropriating funds to carry out any provisions of the healthcare reform law.

That same GOP bill would take back large chunks of money authorized, but not yet obligated, under the economic stimulus legislation of 2009, the American Recovery and Reinvestment Act. The bill also would repeal the section of the stimulus that promises billions of dollars in incentives to physicians and hospitals that demonstrate meaningful use of electronic health record technology.

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