Even as they increasingly embrace Obamacare, Senate Democrats facing tough re-election campaigns are proposing some major fixes to the law. But significant changes are not likely to happen until after the November elections, if then, experts say.
Congressional Democratic leaders and the White House have to decide whether it's worth the risk to allow legislation changing the Patient Protection and Affordable Care Act to go forward. They clearly would like to give endangered Senate Democrats an opportunity to show voters they are working to fix problems with the unpopular law. But they don't want to open up the ACA to Republican attempts to gut it.
“I think Democrats would realize pretty quickly that it would be a mistake to open up the law,” said Republican strategist Brian Gottlieb, managing director of Purple Insights, a polling firm for Purple Strategies, a bi-partisan public affairs company.
President Barack Obama recently has encouraged Democrats to strongly support the law as part of their election campaigns. Senate Majority Leader Harry Reid (D-Nev.) has not signaled whether he will bring any of the proposed measures to the floor, especially before November. And the White House has not expressed interest in helping move the proposals forward.
Efforts to modify the ACA may have less political urgency, given the White House's recent announcement that Obamacare enrollment on the federal and state insurance exchanges had reached 8 million, as well as a growing perception that the law is at least partially succeeding. “The concern level among Democrats has gone down since enrollment hit the 7 million mark and it's only going to get better,” Democratic strategist Tad Devine said. Trying to make changes that could pass the House and Senate before the midterms is a lost cause, he added.
Last month, Sens. Mark Begich (D-Alaska), Mary Landrieu (D-La.) and Mark Warner (D-Va.), who are up for re-election this year, along with Sens. Heidi Heitkamp (D-N.D.), Joe Manchin (D-W. Va.) and Angus King (I-Maine), offered several proposals they said they believed would improve the ACA.
To help more small businesses offer health insurance to their workers, one proposal would provide tax credits to businesses with fewer than 50 employees that would pay for at least half of their workers' health-insurance premiums. That's double the current small-business cap covering fewer than 25 employees. The proposal also would exempt companies with fewer than 100 employees — up from 50 employees — from the requirement that companies offer coverage. In addition, it would direct state insurance regulators to develop models for their states to sell insurance across state lines, something Republicans favor.
Other provisions would boost start-up funding for consumer-governed health insurance cooperatives, and give consumers alternative ways to enroll in health plans and qualify for premium subsidies other than through the insurance exchanges, such as signing up directly with insurers or brokers.
The Democratic senators also proposed the creation of a new, lower-cost insurance plan on the exchanges, in addition to the four metal plans already offered. The so-called “copper plan” — which has support from America's Health Insurance Plans and the National Retail Federation — would offer lower premiums but carry higher out-of-pocket costs.
“By providing a new, lower-cost, high-deductible option … we will give consumers more control over their own coverage, spur competition and, most importantly, increase affordability,” the lawmakers wrote in an op-ed published in Politico last month.
Critics, however, say many consumers already find deductibles and other out-of-pocket costs for bronze plans, the current lowest-cost tier, unaffordable, and believe that copper plans would have limited appeal.
Though these are the first broad Democratic proposals aimed at improving the law instead of replacing it — an approach polls show most Americans favor — political strategists say these measures are unlikely to gain political momentum until after the elections. And they may face an uphill battle even after that.
“It's going to be very difficult,” Devine said. “I don't see Republicans changing their posture on this, especially before the elections, since they need to energize their base by attacking Obamacare.”
Devine suggested a wiser political strategy for Democrats would be to steer clear of healthcare and focus on other issues, such as the economy. “That's what voters want Congress and the president to focus on. Not infighting over this law,” he said.
A New York Times/Kaiser Family Foundation poll released Wednesday found that a majority of residents in three southern, strongly Republican states said they favor keeping the law and making fixes to it, rather than repealing it.
However, most congressional Republicans have continued to argue that Obamacare should be repealed, though they have not come together around any legislation to replace it. Many are using the law as their top campaign issue. “The ACA overall is toxic with Republicans,” Gottlieb said. “If (Republicans) started saying 'Let's fix it,' they would lose some intensity going into the elections and people might not turn out for the vote.”
Still, a few Republicans, including Sen. John McCain (R-Ariz.) have expressed interest in moving forward with fixes to the law.
But improvements appear to be slow-moving on Capitol Hill. “The (Democratic senators') proposals were offered up to restart the conversation on fixing the law, instead of just repealing and replacing it,” said an aide to a Democratic senator who faces a difficult re-election campaign. “We're still working with other offices to get support for them.”
However, real-life policy and market issues pose hurdles to making changes in the law now. A legislative aide to another Democratic senator said some of the changes, including creating a copper-tier plan, likely wouldn't be put in place until 2016 because insurers are currently preparing to submit their 2015 rates for the existing types of exchange plans in June. “This is something that doesn't need to be addressed right away, since it won't take effect until next year,” the aide said.
Proposals that could be addressed sooner, the aide said, are those involving the size of businesses subject to the employer mandate and the broadening of premium tax credits for smaller employers.
Modern Healthcare is a sister publication of Business Insurance.