The U.S. Chamber of Commerce has accepted that the Patient Protection and Affordable Care Act is here to stay and, rather than continue calling for its complete repeal, will work this year to change what it sees as flaws in the 2010 law, the business group's president and CEO said Wednesday.

Outlining the chamber's 2014 priorities, Thomas Donohue, the group's president and CEO, sounded realistic about the statute that his organization had once wanted Congress to repeal and that Mr. Donohue said posed the single greatest threat to the future of American enterprise.

“The administration is obviously committed to keeping the law in place, so the chamber has been working pragmatically to fix those parts of Obamacare that can be fixed — while doing everything we can to make regulations and mandates as manageable as possible for businesses,” Mr. Donohue said in his annual State of American Business address in Washington. “In 2014, we will work to repeal onerous health care taxes; repeal, delay or change the employer mandate; and give companies and their employees more flexibility in the choice of health insurance plans.”

Mr. Donohue also highlighted the need for entitlement reform, as he has in this address in previous years. In 10 years, he noted, the cost for Social Security, Medicare and Medicaid will reach $3 trillion a year, while the share of the budget to pay for those programs — plus interest on the debt — will expand to 76% in 2023 from 65% last year.

“Demographics are destiny and there's no way around it,” Mr. Donohue said. “Americans are living longer. Each and every day another 10,000 baby boomers retire — and that will add up to 77 million new retirees over the next 17 years.”

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In a news conference after his remarks, Mr. Donohue said he believes entitlement reform will not happen for a few more years.

Katie Mahoney, executive director of health policy at the chamber, told Modern Healthcare that the chamber would like to see the Affordable Care Act's health insurance tax and medical device tax repealed, and it also will explore how the law's transitional reinsurance fee might be financed in a different way.

Ms. Mahoney also said the chamber — which represents the interests of more than 3 million businesses of all sizes in all sectors — would also like Congress to repeal the ACA's already-delayed employer mandate. But she acknowledged that in the current political environment, the chamber will take a pragmatic approach and will work to modify the mandate in a way that provides more certainty to businesses.

“Under the statute, applicable large employers — those with 50 or more full-time equivalents — have to offer affordable minimum value coverage to full-time employees, full-time employees being those that work 30 hours or more hours a week,” Ms. Mahoney said. “Historically, full time has been defined as 40 hours a week, and we would like to see that definition be restored.”

Another change would be to simplify the calculation that businesses must complete to determine if they are an applicable large employer. As Ms. Mahoney explained, that term is defined as an organization with 50 or more full-time employees, but how to determine that figure — which takes into account part-time hours, for instance — is often confusing for small businesses.

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Ms. Mahoney echoed Mr. Donohue's approach to the law and offered the reasons why the chamber has laid to rest its efforts to overturn the Affordable Care Act in its entirety.

“The landscape's very different,” Ms. Mahoney said. “We've been through the Supreme Court decision, we've been through another election, and the president is going to be in office for another three years and this is his signature domestic policy,” she added. “So I think to say otherwise would be irrational.”

Jessica Zigmond writes for Modern Healthcare, a sister publication of Business Insurance.