Reform Update: Rifts appear among conservative allies against ACA as midterm elections near

As midterm elections approach, rifts are developing among conservative forces that have been staunch allies in pursuing any means possible to repeal and undermine the Patient Protection and Affordable Care Act. It's not clear, though, whether the change in tone in some quarters signals true resignation to the law's core provisions.

On Wednesday, U.S. Chamber of Commerce's President and CEO Tom Donohue said the nation's largest lobbying group for businesses would aim for targeted changes to the law. In his annual State of American Business address, Donohue said the Obama administration is clearly committed to keeping the law in place and that the chamber will work in 2014 to repeal “onerous healthcare taxes; repeal, delay or change the employer mandate; and give companies and their employees more flexibility in the choice of health insurance plans.”

Meanwhile, the chamber is recruiting and supporting congressional candidates in some races to run against Tea Party-allied candidates. Tea Party-affiliated lawmakers, who have been unbending in the cause of dismantling the healthcare law, pushed Republican House leaders to force a government shutdown over the issue last October. The chamber broke ranks and urged Republican leaders to compromise.

Jodie Curtis, senior government relations director at Drinker Biddle & Reath, said she expects Republicans to continue to target specific provisions of the law. She also expects them to keep demanding documents, information and testimony on the Hill as they question the administration's effectiveness in implementing the law.

“In the House, I think you will continue to see votes on the ACA,” Curtis said, “but I don't think they will be full-out repeal votes.”

In the business community, the clear message is “a shift toward reality,” Craig Garthwaite, assistant professor of strategy at Northwestern University's Kellogg School of Management, said of the agenda that Donohue mapped out.

Garthwaite applauded the approach of the chamber, which represents more than 3 million businesses of different sizes within different industries. “This bill's not going anywhere,” he said, calling the series of symbolic repeal votes in the House a waste of legislative resources. “So the way we improve things is change the bill—not start from scratch.”

For example, he said, eliminating the law's employer mandate—which the chamber would like to see happen—would be an improvement because it's keeping many young and healthy people out of the plans sold on the exchanges because they get coverage at work.

Back from their holiday break, House members on Friday passed legislation that would require HHS to notify consumers within two days after a discovery of any breach of security on the state and federal insurance exchanges. The House approved the one-page bill (PDF) from Rep. Joe Pitts (R-Pa.), chairman of the House Energy and Commerce Health Subcommittee, in a 291-122 vote that included support from 67 Democrats. In a statement of administrative policy, the Obama administration opposed the bill because it said the federal government already has in place an “effective and efficient” system for securing personal information and alerting consumers if their information has been compromised. And the bill “would create unrealistic and costly paperwork requirements that do not improve the safety or security of personally identifiable information” in the exchanges, the statement said.

The White House also opposes a House bill that would amend the healthcare reform law by expanding the reporting requirements related to the insurance exchanges. Introduced last fall by Rep. Lee Terry (R-Neb.), the Exchange Information and Disclosure Act would require HHS to publish weekly reports through March 31, 2015, with information about consumer interactions with HealthCare.gov and calls to the federal customer call center. The report would also name all navigators, certified application counselors who have been trained and certified by the exchanges and agents and brokers who have been trained and certified by the federal exchange. The Obama administration said in a policy statement that the bill would add “extraneous, costly and unprecedented reporting requirements on states and the federal government.” The House plans to vote on the measure next week, according to House Majority Leader Eric Cantor's (R-Va.) office.

A new survey this week from the not-for-profit organization Enroll America showed that 69% of uninsured adults between the ages of 18-64 do not know tax subsidies or financial help are available, while 59% also lack knowledge about new plans available in their state. The organization was established to help build awareness about the Affordable Care Act and increase the number of uninsured who receive coverage under the law. Results came from the conducted by research firm PerryUndem between Dec. 12-22.

Mark Newton, CEO of Swedish Covenant Hospital, said in a statement that his facility has reached out to the community to bridge the information gap. “Swedish Covenant Hospital has been preparing with our community throughout 2013,” Newton said in a brief statement. “We facilitated navigators and organized more than 50 meetings with community leaders, representing a wide diversity of ethnic populations. Delays in information flow is completely common in the normal course of business,” he continued. “We have people working with patients every day to assist them in validating coverage. This is what we are prepared for.”

Follow Jessica Zigmond on Twitter: @MHjzigmond