With the government shutdown entering its seventh day with the Affordable Care Act at the center of the debate, President Obama has said he is open to discuss potential changes to his landmark reform law—but what would be on the table?
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In an interview last week with the Associated Press, President Barack Obama said he would be “happy” to negotiate on health-care reform, but only after Congress resolves its budget issues and re-opens the government. The negotiations would be part of a larger compromise or “grand bargain,” he said.
“We are happy to talk about the health care law, we're happy to talk about the budget, we're happy to talk about deficit reduction, we're happy to talk about investments. But what we can't do is keep engaging in this sort of brinksmanship where a small faction of the Republican Party ends up forcing them into brinksmanship to see if they can somehow get more from negotiations by threatening to shut down the government or threatening America not paying its bills.”
Yevgeniy Feyman, Manhattan Institute fellow at the Center for Medical Progress, says the president may be more willing to use his reform act as a bargaining tool after its rough rollout last week.
“I think Obama’s newfound position is reacting to some dissent,” Feyman says.
And if Republican lawmakers play their cards right, Feyman thinks they could get an altered health-care reform.
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“For example, a lot of the bronze plans have high deductibles and that is what conservatives want to see in health care,” he says. “Also, they want better education about health savings accounts, and want to get subsidy [eligibility] down to 300% of the federal poverty level, like what was done in Massachusetts.”
And just as Congress seems divided on ObamaCare, so too are the American people. With just about one week of open enrollment under its belt, the law is drawing mixed reactions from consumers. A new survey from Bankrate.com finds 46% of Americans would choose to repeal the legislation, while 46% would like to keep the law.
Alye Senger, research associate at the Heritage Foundation, says there are two potential changes on the table for ObamaCare. One would be repealing the 2.3% medical device, which already has bipartisan support.
“Both parties want to get rid of this, and it’s not a big surprise or win for anyone,” Senger says. “I think this would have little significance.”
The larger portion of the law being pushed for a delay is the individual mandate, which is in many ways at the heart of what funds and allows the ACA to function.
The mandate states every individual in the country has to obtain health insurance by March 31, 2014 or face a penalty of $95 per year, or 1% of their annual income, whichever is higher. Republicans want to see this mandate either rolled back to 2015, just like the employer mandate portion or completely repealed.
The latter is less likely, as the individual mandate was upheld as constitutional in a historic Supreme Court decision in 2012.
“If you delay the individual mandate to 2015, you aren’t doing much to the law,” says Senger. “Rolling back the mandate, and repealing the medical device tax, the two most unpopular [portions of the law] wouldn’t be a huge concession.”
Senger says the mandate will also be very “soft” in its first year in particular, so pushing it back wouldn’t damage Obama as much. Looking at the country’s deficit heading into the debt ceiling battle, it’s clear something has to be done, she says.
“We clearly can’t afford the entitlement programs we have today, and [Obama] is expanding one and creating another, with $1.8 trillion in entitlements, these small changes will have small impacts on the constituency,” she says. “The impact of repealing these changes, versus the impact of the law going into effect—there is no question these things should both definitely be on the table.”