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Bipartisan support for health care reform law grows, but challenges remain

Significant hurdles remain in Congress

Mitch McConnell and Harry Reid
Photo by REUTERS Bipartisan efforts to revamp the health care reform law will need support from congressional leaders Senate Minority Leader Mitch McConnell, left, and Majority Leader Harry Reid.

For the first time in more than two years, congressional Democrats and Republicans are uniting to try to amend the much-maligned health care reform law.

This is a big change in Congress because House Republicans have repeatedly focused their legislative efforts on repealing — not amending — the law, while Democrats concentrated efforts on resisting those repeal attempts.

In recent weeks, proposals to delay one soon-to-take-effect Patient Protection and Affordable Care Act provision to impose new taxes on health insurers and a second provision to require most individuals to enroll in a health care plan or pay a fine have received bipartisan support.

In addition, some earlier proposals, such as one introduced in June that would ease a health care law requirement that employers offer coverage to full-time employees or pay a penalty, now have support from members of both political parties.

Even the regulatory agencies seem more open to consider changes to the law.

For example, the U.S. Department of Health and Health Services disclosed last week that it will propose a slight relaxation of a provision that requires all health care sponsors to pay a so-called reinsurance fee effective next year to partially offset costs incurred by insurers covering high-cost individuals buying coverage in public exchanges.

Whether these new bipartisan steps — and perhaps others yet to come — to amend the law will be backed by congressional Republican and Democratic leaders, as well as the Obama administration, remains to be seen.

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Some Washington observers say forging bipartisan agreements to amend the health care reform law still faces rough sledding.

“There still is no widespread appetite” in Congress to amend the law, said Gretchen Young, senior vice president of health care policy at the ERISA Industry Committee in Washington.

“In the current political climate, it still is very unlikely, if not impossible, to address needed” changes to the law, said Eric Zimmerman, a partner with McDermott, Will & Emery L.L.P. in Washington.

Others say legislative changes are possible.

“There could be opportunities for some bipartisan agreements,” said Geoff Manville, a principal with Mercer L.L.C. in Washington.

It was only a couple of years ago when Republicans and Democrats were able to work together on making health care reform law changes. For example, in 2011, Congress, with little dissent, approved a measure repealing a provision that would have required employers to offer low-wage employees company-paid vouchers to buy coverage in public health insurance exchanges.

Business groups strongly opposed the requirement, arguing that it would boost employer costs and add administrative complexity.

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In 2011, Congress also agreed on another tweak to the law, repealing a provision that would have required employers to furnish Form 1099s if they did more than $600 in business with a corporate vendor.

Since those attempts two years ago, bipartisan efforts to amend ACA have largely dried up.

Now some Republicans and Democrats are joining forces in the wake of a politically unpopular move by Republicans last month, when they blocked for two weeks legislation to keep the federal government fully running as leverage for repealing the health reform law, are focusing on targeted changes to it.

For example, last week Reps. Ami Bera, D-Calif., and Charles Boustany, R-La., co-sponsored legislation that would delay a provision that imposes a new tax on health insurers until 2016, a two-year delay.

“We need to work together to fix the areas of it that are problematic and make it work better for the American people,” Rep. Bera said in introducing the bill.

By delaying the tax, which Rep. Bera said insurers would pass on to employers and individuals in the form of higher premiums, health insurance markets would have more time to stabilize while providing immediate relief to buyers, he said.

In addition, Sen. Susan Collins, R-Maine, has secured support from several congressional Democrats, including Sens. Jon Donnelly, D-Ind., and Joe Manchin, D-W.Va., for her proposal that would amend the law's definition of a full-time employee, shielding more employers from a fine imposed by the law.

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Under the law, employers are required to offer qualified coverage to full-time employees — defined as those working an average of 30 hours per week — or be liable for a $2,000 penalty per employee in 2015.

Under the Collins bill, the definition of full-time employees would be those working an average of 40 hours per week.

Experts say without a change in law, some employers will reduce hours worked by employees whom they consider to be part-time, such as those working 35 hours a week or less and have not extended health care coverage, to below the 30-hour threshold set in the law to avoid the $2,000 penalty.

“Traditionally, employers have required employees to work more than 30 hours a week to be eligible for benefits,” said Amy Bergner, managing director of human resources solutions at PricewaterhouseCoopers L.L.P. in Washington.

Without amending the law, some employers would reduce employees' hours, which was not the intent of the law, Ms. Bergner added.

Federal lawmakers aren't the only ones who will be shaping the health care reform law in the coming months.

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A federal judge in Washington, for example, said he will rule early next year on a suit challenging an Internal Revenue Service rule that says federal premium subsidies are available to lower-income uninsured individuals seeking coverage in public insurance exchanges.

The plaintiffs argue that under the law, the subsidies are available only in state exchanges and not the 34 states where the federal government established exchanges after the states declined to do so.

If the plaintiffs prevail, millions of people living in states that declined to set up exchanges would lack access to premium subsidies, making it unlikely that the law's central purpose of significantly reducing the number of uninsured would be achieved.

In 2012, 48 million U.S. residents were uninsured, according to the U.S. Census Bureau.

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