Reform Update: Don't expect Obamacare alternative from GOP, experts say

A dearth of news during a congressional recess might explain a flurry of stories this week about the healthcare strategy Republicans will promote in this year of midterm elections. By Friday, policy analysts and academics—along with a House GOP leadership aide—made it clear: A substantive healthcare proposal from Republicans won't appear any time soon.

Approaching its fourth anniversary on Sunday, the battle-weary Patient Protection and Affordable Act seems far older than its years. The controversial law is now a permanent fixture in society, and some of its most important reforms are taking hold—about 5 million Americans have signed up for healthcare coverage on the insurance exchanges, the CMS reported this week. At the same time, the 2010 healthcare overhaul remains wildly unpopular among millions of other Americans while politicians rev up for the November elections.

While the ongoing tension between supporters and opponents of the law persist, policy analysts and political scientists weighed in about what the U.S. electorate can expect from GOP lawmakers as they seek to maintain the speaker's gavel in the House and recapture the Senate in November.

Larry Jacobs, a political science professor at the University of Minnesota, said he expects the economy, not the Affordable Care Act, to be the major issue leading up to the elections. But he added that the law will come into play for Republicans for a reason unrelated to healthcare: voter turnout. Although most Americans don't want to see the law repealed, Jacobs said, the Republican Party's base remains vehemently opposed to the law and responds enthusiastically to rallying cries for more repeal votes.

“It's about turning out a much smaller number of people who will vote—and will vote Republican—come November,” Jacobs said.

Repeating that familiar pattern of attacking the law suggests GOP lawmakers won't spend time promoting any substantive replacement legislation, despite House Majority Leader Eric Cantor's comment in January that the lower chamber would vote on an ACA alternative this year.

“Cantor is suggesting that the party has to be for something instead of against something, so they're trying to get something together, but it's short on details,” said Michael Mezey, a professor of political science at DePaul University. “The political perspective is they shouldn't do anything before 2014 (midterms) because they hope to do well in the elections and regain the Senate by running against the ACA,” he continued. If GOP leaders propose a healthcare policy that shifts the subject away from the 2010 law, they risk splitting the party. “The Republican base is: Repeal the whole thing,” he said.

Underscoring the predictions from Mezey and Jacobs is the absence of any fundamental healthcare strategy or ACA replacement bill from the GOP. The lower chamber has the House Obamacare Accountability Project, or HOAP, but the group has yet to release any formal proposals. And what of Cantor's promise earlier that the House will come up with a viable ACA alternative?

According to a House GOP leadership aide, discussions in the House are ongoing and lawmakers are still in the “idea phase” of the process.

As for the upper chamber, Jacobs said there has been talk for some time that the GOP can take control of the Senate, and people are taking that prediction more seriously now. But even if Republicans control both chambers of Congress after the November elections, any ACA repeal will still be an uphill climb. Although repeal bills would make it to the Senate floor under a GOP majority, the president would still veto them. Then it would require a two-thirds majority, or 67 votes, to override the president's veto, which isn't likely to happen.

Seeking to repeal the law would also be a formidable challenge, according to both Mezey and Jacobs, because millions of Americans support so many of the law's reforms, such as the health insurance exchanges, preventive care and the medical loss ratio rule, which requires insurers to spend a majority of premium dollars on medical care.

“I don't think we will see a lot of substantive policymaking in Washington for some time,” Jacobs said.

Despite a weeklong recess, the offices of the chairmen and ranking members of the House Ways and Means and Senate Finance committees this week released a discussion draft proposal called the Improving Medicare Post-Acute Care Transformation Act of 2014. Referred to as the IMPACT Act, the bill takes a step toward modernizing Medicare's payments to post-acute care providers. The work is based on recommendations from more than 70 healthcare industry stakeholders and requires standardized data that would allow Medicare to compare quality across all post-acute settings (skilled-nursing facilities, long-term acute-care hospitals and inpatient rehabilitation facilities); improve hospital and post-acute discharge planning; and use that information to reform post-acute payments, either through bundled payments or site-neutral payments.

A new survey from the Robert Wood Johnson Foundation found that 52% of uninsured respondents have looked into their insurance coverage options or plan to look before open enrollment ends on March 31. The findings revealed that those unaware of the health insurance exchanges are more likely to be younger, Hispanic, unemployed and with lower incomes than most uninsured individuals. “Many of the uninsured who have not yet looked at the marketplaces know little or nothing about them and the opportunities for financial assistance to help purchase a plan,” Katherine Hempstead, who focuses on insurance coverage issues at RWJF, said in a news release about the survey.

Follow Jessica Zigmond on Twitter: @MHjzigmond