Big Republican election gains in Congress will position the GOP to aggressively challenge Obamacare in 2015. Now the questions are how sweeping Republican efforts will be to roll back the law, and whether the party will pursue its longstanding goal of restructuring Medicare and Medicaid. Everyone will be watching where President Barack Obama draws the line with his veto pen.
Repealing the Patient Protection and Affordable Care Act was a key campaign issue propelling Republicans to gain control of the Senate and their largest majority in the House since the Great Depression. Sen. Mitch McConnell (R-Ky.), who is expected to be the new Senate majority leader, has vowed to dismantle Obamacare “root and branch.”
Most political observers say the GOP-controlled chambers are likely to vote to repeal the law shortly after convening in January. But given that Republicans won't have a veto-proof majority in either the House or Senate, repeal legislation almost certainly will die with a stroke of a presidential pen. That could tee up healthcare as a marquee issue in the 2016 elections.
Republicans are likely to then turn their focus to picking off controversial provisions of the law. At the top of the list are the 2.3% medical-device tax and the employer mandate. They also may move to change the definition of full-time workers, whom employers have to cover, from 30 to 40 hours a week, and abolish the Medicare Independent Payment Advisory Board, which conservatives have excoriated as a “death panel.”
At a news conference last week, Obama set down some markers. “On healthcare, there are certainly some lines I'm going to draw,” he said. “Repeal of the law I won't sign. Efforts that would take away healthcare from the 10 million people who now have it and the millions more who are now eligible to get it, we're not going to support.” While he said he's open to some changes, he said he would not sign anything that would “undermine the structure of the law.”
But certain GOP proposals may have some Democratic support. Scrapping the medical-device tax won the backing of some liberal Democrats in the past, passing the Senate by a 79-20 non-binding vote last year. But repealing the tax would cost $29 billion over a decade, and there is no agreement on how to fill that funding gap.