GOP plots Obamacare agenda if they take Senate

If Republicans win control of the Senate in November, they almost certainly will vote to repeal Obamacare, joining House Republicans in that effort. But there's zero chance that President Barack Obama will sign a repeal bill.

After that symbolic vote, most conservative analysts expect Republicans to focus their real energy on repealing provisions of the law that provide significant funding for the law's premium subsidies. Some of those efforts could draw Democratic votes.

Topping the GOP hit list are the medical-device tax—projected to yield $29 billion over 10 years to help fund the law's premium subsidies—and the requirement that larger employers either provide coverage for their employees or pay a penalty, which is projected to generate $130 billion. Losing that revenue would blow a big hole in Obamacare funding.

Erasing those provisions is likely to get some Democratic support, particularly on the 2.3% device sales tax. Democrats who represent states and districts where medical-device manufacturers are located have opposed the tax. “It's been pretty clear there's a bipartisan coalition in the House and Senate that believes the medical-device tax has been very harmful to jobs,” said Rep. Erik Paulsen (R-Minn.), chief sponsor of the House proposal.

But some experts question the device industry's claims that the tax is hurting companies, noting that the tax applies to imported devices, so there's no financial incentive for healthcare providers to switch to foreign suppliers, and that it does not apply to exported products.

Republicans also are likely to push for allowing insurers to sell health plans across state lines without being regulated in every state, arguing that will drive down premiums. But state insurance commissioners argue that would limit their ability to protect consumers against insurance abuses.

If Republicans move to repeal the device tax and the employer penalty, they either will have to find a way to offset the revenue losses or accept an increase in the budget deficit. That could rile up fiscally conservative Republicans. “Virtually anything you can think of that might be sensible bangs up against CBO scoring,” said Joe Antos, a healthcare policy expert at the conservative American Enterprise Institute.

“I think, ultimately, the president will be open to some changes,” said Yevgeniy Feyman, a fellow at the conservative Manhattan Institute who studies healthcare issues. “But I don't think radical changes are realistic while there's no veto-proof majority or while Obama's still in office.”

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