The Republican Landslide and the Affordable Care Act

After their resounding triumph in yesterday’s midterm elections, House Republicans will likely act on their promise to repeal the Affordable Care Act, the health reform bill President Obama signed into law last March.

Their efforts could be blocked by the Democratically controlled Senate or, if necessary, by a veto from the Big O himself. But the Boehners might still get the final say, since they have the power to halt appropriations funding for large swaths of the law.

These realities have health-industry groups, some of whom vigorously supported Democratic efforts to pass the law, cozying-up to the GOP like a Snuggie on a cold winter night.

Private insurers want Congress to nix that $70 billion tax that will be levied against them beginning in 2014. They’d also like lawmakers to permit them to widen the rating bands which cap the amount of money they can charge older enrollees.

Insurers and providers want Congress to add a tort reform rider to the law, preferably one that protects physicians against malpractice lawsuits if they adhere to best practice guidelines. Drug companies want to kill the proposed Independent Payment Advisory Board, whose job it is supposed to be to control the rate of growth in Medicare spending. The Board’s recommendations would, after all, likely include reduced federal spending on prescription drugs which is very bad for their business.

Yet these same groups are worried sick that Republicans might go too far in their zeal to repeal the deal. The baby in the bathwater for these trade groups is the individual mandate: a provision in the law that requires most Americans to carry health insurance.

Many House Republicans detest the mandate, believing it to be an affront to personal liberties or whatever. Of course when providers and insurers look at it, they see an unprecedented revenue bonanza! So they are busy as bees conjuring up alternatives that appease the Boehners and let them cash-in at the same time.

The alternatives they’ve come up with so far include levying higher rates on people that choose not to purchase insurance in the first years after the law goes into effect, and auto-enrolling folks into coverage subsidy programs for which they are eligible. Those woebegone Dems will remind anybody who cares to listen that they considered automatic enrollment before bagging it on account of implementation difficulties and other snafus, but nobody is listening to them right now anyway.

“We’re open to lots of different ideas” for assuring access to affordable coverage, Wes Metheny told the Wall Street Journal recently. An SVP at the Pharmaceutical Research and Manufacturers of America, Metheny added, “we were very supportive of health-care reform last year and there are some good things we think need to stay in place.”

Meanwhile, the folks who penned the Affordable Care Act in the first place are more worried about misguided Republican smart-bomb attacks on selected portions of the law than they are about a full-on repeal.

Those “smart” bombs could destroy the financial underpinnings of their insurance exchanges, for example.

Worse yet would be a situation in which the Feds are left to enforce provisions requiring insurers to cover folks with pre-existing medical conditions even after a “smart” bomb has destroyed the individual mandate. In this nightmare scenario, insurers including Medicare end up with a very sick customer base and no way to spread the costs.

Then again, if past history is any indication, we can rest assured that cooler heads will prevail and our newly elected officials will do the right thing. Riiiight.

Glenn Laffel, MD, PhD, was formerly Senior Vice President for Clinical Affairs at Practice Fusion and is now CEO, HealthResults.

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