With Congress returning from its summer recess this week, Republicans intent on demonstrating their opposition to the Affordable Care Act should have plenty of opportunities.
Before the end of the month, lawmakers will have to resolve their annual budget impasse. Whether they pass a budget (unlikely) or another continuing resolution, the budget debate offers a perfect vehicle for chipping away at several health law taxes whose repeal has gained bipartisan support. There is also growing sentiment for changing the ACA's unpopular small-business mandate.
As presidential candidates from the congressional ranks look to make news, those hot-button health policy issues could see vociferous debate.
But the red-meat issue animating the social conservative wing of the GOP—defunding Planned Parenthood—stands in the way of making even minor changes in the law, which otherwise might be achievable. Party hard-liners intent on grabbing the spotlight will get their chance starting Wednesday with congressional hearings.
Planned Parenthood has come under withering assault since an anti-abortion group's undercover videos showed staffers discussing fetal tissue donation. “I think this is going to be an ugly, ugly period,” said Brookings Institution senior fellow Henry Aaron. He called the hearings a political instrument, not a legislative vehicle.
So success in making minor changes to the Affordable Care Act—anything major will face a presidential veto—will depend on whether Republican leadership can keep its conservative wing in check. GOP leaders say they don't want a government shutdown. Lawmakers like Sen. Orrin Hatch (R-Utah) have said they would like to target the health law tax measures specifically rather than insist exclusively on a full repeal of the ACA.
Tim Jost, emeritus law professor at Washington and Lee University, said ACA changes, especially nixing a mandate to expand the small-group insurance market to include businesses with up to 100 employees, are certainly possible if untenable riders aren't added.