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Republicans take aim at health care reform law with proposed revisions

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Republican-backed proposals to amend the health care reform law will not share the same fate as those in prior congressional sessions, as the GOP regained control of the U.S. Senate after the November elections while adding to their majority in the House.

That means House-passed measures to revamp the law no longer will be dead on arrival in the Senate.

But how many, if any, GOP-backed proposals on amending the Patient Protection and Affordable Care Act will become law is less certain. With 55 members in the Senate, Republicans would need bipartisan support to muster the 60 votes needed to stop Democratic filibusters or the 67 votes needed to overturn a presidential veto.

“The bottom line is there is not much Congress can do to seriously weaken the law given who is president,” said Geoffrey Manville, a principal at Mercer L.L.C. in Washington.

“Lawmakers may make some changes around the edges, but I don't see significant changes,” said Katy Spangler, senior vice president of health policy at the American Benefits Council in Washington.

Still, Washington benefit observers are not ruling out all changes.

The change that may have the best chance of passage — changing the definition of a full-time employee — is one the House approved in 2014 but on which the Senate never acted.

Instead of defining full-time employees as those working an average of 30 hours per week, a broad array of business groups have backed legislation to change that to 40 hours per week, in part to avoid a $2,000 per employee penalty for not offering health coverage to at least 70% of their full-time employees this year and 95% in 2016 and succeeding years.

“That is a big one,” Mercer's Mr. Manville said, referring to the 30-hour-per-week standard in the health care reform law.

In certain industries, such as retail and hospitality, coverage rarely is extended to employees working as few as 30 hours a week. That leaves employers with a difficult choice: face higher costs for covering more workers or pay the ACA penalty for not offering the coverage to a high enough percentage of employees.

“There is a good deal of bipartisan support” to change the definition of full-time employee to 40 hours, said Steve Wojcik, vice president of public policy at the National Business Group on Health in Washington.

Indeed, 12 Democrats joined Republicans when the House, earlier this month, again approved the measure bumping up the definition of full-time employees as those working an average of 40 hours per week. The Senate has not yet taken up the measure.

Still, President Barack Obama has threatened to veto such a change, contending it would reduce the number of people with health insurance coverage by 1 million. Experts say the GOP would struggle to muster votes to override such a veto.

Repealing a requirement that employers with at least 200 employees automatically enroll employees who do not select a health plan also “has the potential of repeal,” said Ann Marie Breheny, a senior legislative adviser at Towers Watson & Co. in Arlington, Virginia.

One factor that could boost the chances of lawmakers eliminating automatic enrollment is that the requirement hasn't yet gone into effect.

“When there is nothing to undo, repeal is easier,” Ms. Breheny said.

Another item high on employers' list of ACA provisions they would like to see repealed or amended is the 40% excise tax on high-cost health plan premiums that is to go into effect in 2018.

A big unknown — one that could make the administration more receptive to accepting certain changes — is how the U.S. Supreme Court will rule in a key health reform law case.

In David King et al. v. Sylvia Matthews Burwell et al., the high court will hear oral arguments March 4 on whether lower-income people who are uninsured can use federal premium subsidies to obtain coverage in federal exchanges.

If the high court tosses out the IRS rules, that could make the Obama administration more receptive to legislative change on the exchange issue and “could open the door for negotiations on other provisions,” said Gretchen Young, vice president of health policy at the ERISA Industry Committee in Washington.