Healthcare lobbyists across Washington are hoping to win long-sought changes to ObamaCare now that the Supreme Court has affirmed the law is here to stay.
Last week’s ruling in King v. Burwell has unfrozen the field for dozens of healthcare groups that have been stymied in their efforts to tweak the law while it was still fighting for survival in the courts.
“We’re no longer talking about dismantling the law, so maybe it’s time to move out of that mode and start talking about improvements,” said Mary Grealy, president of the Healthcare Leadership Council.
The list of proposed tweaks is long. The most popular repeal items include the so-called “Cadillac” tax on health plans, the medical device tax, the 30-hour workweek rule and the cost-cutting panel known as the Independent Payment Advisory Board (IPAB).
“There was a sense that King v. Burwell would be an unraveling of the Affordable Care Act,” Grealy said. “Certainly the repeal of IPAB and the repeal of the medical device tax can’t be viewed as an unraveling.”
The National Coalition on Benefits, which includes the country’s biggest trade groups and companies, sent a letter to the Senate Finance and the House Ways and Means committees on Tuesday urging a repeal of the Cadillac tax.
The 40 percent excise tax on high-cost healthcare plans goes into effect in 2018, and the National Coalition on Benefits warns that it could impact as many as 25 percent of all employer-sponsored plans.
“At the very least, this provision will increase the cost of health care coverage, unintentionally encourage significant benefit design changes, discourage efforts to promote wellness, prevention, and diminish the ability for America’s employees to pay for out-of-pocket costs,” the group wrote in the letter.
While the Obama administration has said it is open to bipartisan fixes to the law, it has not backed any of the reforms proposed by Republicans.
Health and Human Services Secretary Sylvia Mathews Burwell told reporters this week that she couldn’t support an effort to repeal the medical device tax, for example, because it’s not seen as an improvement to the law.
“We want to build, we want to make it better, but we’ve been clear, we’re going to measure things by … does it improve affordability? Does it improve access? Does it improve quality? How does it interact with the economy?” she said.
She pointed out that repealing the medical device tax would add $24 billion to the deficit, according to the Congressional Budget Office.
She also cast doubt on the impact that the 2.3-percent tax is having on the medical device industry, adding that her analysis hasn’t shown “highly measurable job impacts” from the tax.
Before Thursday’s decision, which put to rest an eight-monthlong legal challenge, business groups complained that they couldn’t get lawmakers on board with repeal of even the more unpopular parts of ObamaCare.
“For better or worse, the King case took a lot of the political air out of the system when it came to healthcare,” said Neil Trautwein of the National Retail Foundation.
“It was hard for members to commit to supporting particular ideas with the prospect of potentially having to rescue or rewrite the Affordable Care Act.”
As Republicans in Congress rushed to create contingency plans for the ruling, they had less time — and attention — to dedicate to looking at other parts of the law. On K Street, healthcare groups and law firms were coming up with their own plans to advise clients and members in case the Obama administration lost in court.
“It appeared as though Washington in general and the country was sort of holding its breath in anticipation,” said Katie Mahoney, executive director of healthcare policy at the Chamber of Commerce.
“In order to understand what the landscape was going to be, I think people were very eager to see what the court would hand down,” she added.
Now, the law is virtually guaranteed to remain in place for the rest of President Obama’s tenure, further entrenching ObamaCare as a new entitlement to stand alongside Medicare and Social Security.
Already, groups ranging from the American Heart Association to the American Association of Neurological Surgeons are kick-starting their campaigns to win changes to the law.
Some of the repeal efforts — such as the medical device tax and IPAB — have already gotten votes in the House.
But there are plenty of other ideas that have received little traction from lawmakers, such as cutting down the reporting requirements for businesses, downsizing the essential health benefits provisions, creating a fix for seasonal employees and eliminating the health insurance tax.
The challenge will be corralling the many business groups that are each pushing their own ObamaCare agenda.
“There are so many different changes and so many different groups pushing these changes,” said Trautwein. “There’s a bit of overlap, but really, it’s a cast of thousands.”