During what was designed to be a white-flag waving of sorts, a promise that partisan differences will not stand in the way of legislative action in the upcoming Republican-controlled Congress, newly re-elected GOP Sen. Mitch McConnell of Kentucky, and new Majority Leader, did not hesitate to give his opinion of the Affordable Care Act. And with the midterm elections decided, and Republicans in control of a four-seat majority in the upper house of Congress, changing the Affordable Care is a major part of the party’s agenda.
Jeopardizing the future of the Affordable Care Act is a case on the docket of the Supreme Court, waiting for the oral arguments that begin in March. Already the Supreme Court has made several key decision regarding the future of Obamacare. In 2012, the 9-justice panel decided (by a narrow five to four margin) that the Affordable Care Act’s individual mandate was a valid exercise of Congress’s power to tax, meaning the tax penalty that was designed to ensure most Americans purchase insurance is constitutionally sound. Last June, the court decided that closely-held for-profit companies can claim an exemption to the Affordable Care Act’s contraceptive coverage requirement. Now the Supreme Court must now decide whether Congress meant to provide federal subsidies to both Americans who purchased insurance coverage through the exchanges set up by the states and those who bought plans via the exchanges designed and operated by the federal government on behalf of 36 states.
What is the Save American Workers Act?
The major campaign congressional Republicans launched this week to derail the health care reform poses much more immediate danger. Despite President Barack Obama’s pledge to veto, House of Representatives easily passed legislation Thursday that revised the Affordable Care Act’s definition of a full-time workweek to 40 hours. As written, the heath care reform law’s employer mandate — which was delayed for two years before its January 2015 implementation — dictates that companies with 50 or more employees provide coverage to all full-time workers, with 30 hours as the standard workweek. This plan was meant to prevent companies from dropping employer-sponsored coverage once the Obamacare insurance exchanges began offering alternate coverage options. But Republicans argue the mandate encourages employers to cut their workers’ hours to 29 per week, or lower, in order to avoid additional labor costs. By comparison, GOP lawmakers say the Save American Workers Act will help the most vulnerable workers — those in low-skilled, low-paid positions — by keeping their workweeks intact.
How has the Affordable Care impacted the job market.
Much controversy surrounds the degree to which the Affordable Care Act has impacted the workweek of the low-wage American worker. This chart from Investor’s Business Daily contextualizes the changes in the average length of workweeks; since 2012, the number of workers logging more than 30 hours per week has dropped as those working less than 30 hours per week has increased.
The ObamaCare employer mandate is hurting low-wage workers. But this fix may make matters worse. http://t.co/iceRHA2cMz
— Investors.com (@IBDinvestors) January 9, 2015
According to a January 7 cost estimate from the Congressional Budget Office, if the “full-time” threshold is lifted to 40 hours per week, the number of people receiving employment-based coverage will be reduced by one million, while the number of people obtaining coverage through a government program (including Medicaid and the health insurance exchanges) will rise by 500,000 to one million. Plus, the number of uninsured Americans will rise by around 500,000 people.
Paul Ryan — Wisconsin’s Republican representative who ran as Mitt Romney’s 2012 running mate — acknowledged in a opinion piece published in USA Today on January 6 that the Save American Workers Act will not “fix” Obamacare, a law will “collapse under its own weight.” By passing a bill to “restore” the traditional workweek, Republicans claim they are starting “to get rid of its worst features.” In describing the unmanageable weight of the Affordable Care Act, Ryan stuck to the standard Republican argument: the individual and employer mandate places an undue burden on American taxpayers, the economy, the business community and the medical profession. If enacted, this bill will enable “more people [to] work full time,” Ryan concluded.
However, it can easily be argued that this so-called start to ridding the Affordable Care Act of its worst features is hardly progress. Republicans say increasing the “full-time” threshold will save jobs and paychecks. Obviously, it will also mean the loss of employer-mandated coverage for a million Americans. And, it could also mean that employers will merely cut workers’ hours to below 40 per week to again save on labor costs, as Robert Greenstein, the president of the left-leaning Center on Budget and Policy Priorities, commented Wednesday. In fact, Greenstein sees this Republican claim as a blatant lie. “While political leaders often stretch the truth to make their case, they usually don’t claim the opposite of the truth,” he wrote in a blog post. “That, however, is essentially what Republican congressional leaders are doing.”
Can Republicans really change the Affordable Care Act?
Of course, since the passage of Obamacare in 2010, the House of Representatives has passed more than 50 different bills aimed at defunding or repealing all or portions of the Affordable Care Act. But, with the midterm elections giving the GOP a new majority in the upper house of Congress, this measure marks the time the House can advance legislation to the Senate with hopes the legislation will end up on the president’s desk. Still, in the Senate, the Republican party does not have the 60 votes needed to overturn a presidential veto or overcome a Democratic filibuster, and business leaders in the retail, restaurant, and hospitality sectors (who favor this change in the workweek definition) are after bipartisan support. And the Save American Workers Act did garner 12 votes from House Democrats
Can Republicans live up to election promises?
At his post-election press conference, McConnell announced that every one of his members thinks Obamacare is a “huge legislative mistake” that has “fouled up the health insurance market and put states in a deep hole in terms of Medicaid expansion.” If McConnell had he ability he would “obviously get rid of it.” And in an opinion piece published in The Wall Street Journal, both McConnell and Speaker of the House John Boehner, the Ohio Republican who also won re-election last November, wrote that with the Senate majority won, the party was “renewing [its] commitment to repeal ObamaCare, which is hurting the job market along with Americans’ health care.”
While McConnell shied away from using the term “repeal” in his press conference, he too expressed a desire to knock out the most unpopular provisions of the health care reform law. “There are pieces of it that are deeply unpopular with the American people,” he stated. “The medical device tax has exported an enormous number of jobs. The Loss of the 40 hour work week is a big mistake. That ought to be restored. The Individual mandate, people hate it.”
In lieu of discussing repeal, McConnell simply noted that Senate Republicans “will be addressing” the Obamacare issue in “a variety of different ways.” What bears remembering is that despite McConnell’s promise to work with the Obama administration, there likely to be tensions in the Republican party itself, and compromise between Congress and the White House on major and divisive politics like immigration and health care will be nearly impossible. Many new GOP senators were elected on opposing amnesty and repealing Obamacare. And promises to the electorate cannot be broken or the party’s chances at the presidency in 2016 may be hurt.
Conservative groups and activists who were hugely influential in helping Republican lawmakers win election have already began reminding these politicians of their promises. On Wednesday, a coalition of conservative groups — from Citizens United to the Susan B. Anthony List to Tea Party Patriots — met in Washington D.C. to listen to McConnell’s statement and discuss how Republican leaders must “earn” their majority. Brent Bozell — a conservative writer and activist who heads For American, a non-profit tasked with invigorating “the American people with the principles of American exceptionalism” — emphasized that the Republican candidates who won opposed the Affordable Care Act. “The Republican Party ran 35,000 TV ads about Obamacare alone in the month of October alone,” he said, to prove that point.
It was Bozell’s belief that the “first act of the new majority in Congress must be to keep its promise.” Conservative voters “will hold each and every single Republican candidate who won last night accountable for his or her promises.” Republicans “need to move to repeal Obamacare as fast as the doors of the new Congress swing open. Challenge the president to veto this legislation; take that veto to the American people; have a debate.” And if the party follows that tact, he bombastically promised that “Republicans will win the presidency in 2016, I guarantee it.”
There is no denying that the 2010 health care law was an important election issue; according to the most recent Kaiser Family Foundation health tracking poll, 84% of respondents said Obamacare was at least somewhat important to their vote. Across party lines, the Affordable Care Act ranked as the fourth most important issue. But public opinion tells a nuanced story. That health tracking poll found that the public is more likely to express an unfavorable view of the health care reform than a favorable one, by a margin of 43% to 36%. Roughly, the percentages of Americans holding negative opinions and positive opinions have stayed constant since the law was passed in March 2010. But while public opinion is sharply negative, only small shares of Americans believe the health care reform law should be repealed. Two-thirds want to see their congressperson to work to improve the law, even though most Americans (Republicans, Independents, and Democrats alike) report experience no direct impact from the law. And when Republicans say their constituents want them to continue the debate over the Affordable Care Act, that is not much of an exaggeration; a full 62% think Obamacare should remain an issue, while only 44% of Independents and 28% of Democrats feel the same.
The basis of this enduring negativity is complex. It is partly a product of the political upheaval created by the debate over the reform, partly born out of concerns that the structure foundation of the Affordable Care Act is weak, and partly because the law’s politics have overshadowed its actual impact. As survey data shows, the law has had little impact on most Americans, meaning much negativity is based on perceptions of the danger Obamacare could pose to employment and the deficit. And so much negativity is the impetus for repeal talk.
McConnell’s goal is partial repeal, based on his Wednesday comments. And there are important reasons why the goal is only partial repeal. For one, a number of private sector companies have benefited from the reform; in the past quarter, Tenet Healthcare recorded record revenue of $4.8 billion, which were largely thanks to a reduction in uninsured visits at its hospitals. Plus, Republican victories were not so great that they can do whatever they want. To be clear, while Republicans did pick up seats in the House, giving the party its largest majority since World War Two, experts say Speaker Boehner will still struggle with having a true governing majority. The Republicans majority in the Senate is equally slim, falling short of the 60 needed to bring a bill or nomination to the floor for a vote.
The GOP is likely to focus its attention on several unpopular aspects of Obamacare, in addition to restoring the 40-hour workweek. On the agenda is eliminating the 2.3% medical device tax, a tariff created by the administration to fund insurance subsidies, which manufactures say is hurting competitiveness. The party will also likely try to get rid of the Independent Payment Advisory Board, dubbed the “death panel” by former Alaska Gov. Sarah Palin. While the IPAB was created to reduce Medicaid’s per-person spending, the costs of that program have grown too slowly for the board to launch. But still Republicans argue IPAB will suffer accountability problems and hurt seniors. Sure, the individual mandate — which requires nearly every single American to have health insurance or face a penalty — was upheld by the Supreme Court in 2012. But because the mandate as whole remains unpopular, although its provisions are generally supported, the Republicans are under pressure to disable it. Of course, Obama would never agree to repeal the mandate because it would not only ruin the insurance marketplaces but cause premiums to increase dramatically.
It is by no means surprising that the GOP is so focused on the Affordable Care Act, but it would also serve the party well to concentrate on ideas that go beyond repealing Obamacare and actually fix the American health care system. The reform did not fix health care, and there are many areas that could benefit from new legislation including the payment system and graduate medical education.
Follow Meghan on Twitter @MFoley_WSCS