4 Things to Know About Obamacare After the Midterms

Over the course of this year’s midterm campaign,
Republicans ran endless ads against the Affordable Care Act, the
health care law better known as Obamacare. In weeks leading up to
the vote, it was the top Republican ad issue for Senate campaigns
by far.

So now that Republicans have won majority control of the Senate,
and increased their majority in the House, what might that mean for
Obamacare?

Here are four things to know and watch out for: 

1) Obamacare continues to be political poison for
Democrats.
Of the 60 Senators who voted for Obamacare in
December of 2009, 24 are now out, as The Washington
Examiner
’s Philip Klein
points out
. Now, some of them were replaced by Democrats,
but  and not all of the turnover is strictly the fault of
Obamacare. But the retention rate for upper-chamber legislators who
voted for the law is not strong, and the majority of those who are
gone were replaced by Republicans. It’s worth singling out the
Arkansas Senate race here. Incumbent Democrat Mark Pryor was the
only Democrat in a close Senate contest to run an ad that could
reasonably be described as supportive of Obamacare. Tellingly, the
ad didn’t name the law at all, but it did describe support for some
of its benefits. Pryor lost,
pulling in just 39 percent of the vote
. In contrast, Ed
Gillespie, the GOP Senate candidate in Virginia, was expected to
lose by as much as 9 points. He was the rare GOP Senate candidate
to endorse a relatively detailed Obamacare plan—and he ended up
losing in a squeaker of an election by
less
than a single point.

Pinning down the exact impact of Obamacare on the midterms is
obviously difficult, but there’s solid evidence suggesting that in
2010, voting for the law
cost
Democrats an estimated 25 seats in the House—enough that
they lost control of the lower chamber because of it. Regardless of
exactly how much Obamacare hurt Democrats politically, it’s
virtually impossible to make a case that it helped.

2) The bulk of Obamacare is not going to be
repealed.
Republicans have promised repeatedly to repeal
Obamacare, and in a joint Wall Street Journal op-ed, GOP
Senate Majority Leader Mitch McConnell and House Speaker John
Boehner put “renewing our commitment to repeal Obamacare” near the
top of the party’s priority list. Expect to hear an awful lot about
various
strategies
for using the reconciliation process, which would
allow Republicans to move a partial repeal bill out of the Senate
and to the president’s desk with a simple majority vote. The
details are complicated, and even experts don’t know for certain
exactly how much of Obamacare could be attacked using this
process.

But at least in the short term the particulars don’t matter all
that much. Regardless of the party’s commitment to repeal or its
procedural savvy, the vast majority of the law isn’t going
anywhere, because Obama isn’t going to sign a bill that repeals it.
If it wasn’t already perfectly clear that he wouldn’t agree to
scrap his signature accomplishment, he reiterated his position at a
press conference this week. “Repeal of the law—I won’t sign,”

he said
. That’s that.

McConnell knows this. Boehner knows. Republicans aren’t actually
expecting to fully take the law down. Instead, they hope to keep
pressure on the president regarding the unpopular law, highlighting
the GOP’s continued opposition and Obama’s continued support.

3) Republicans will likely target specific components of
the law—and might actually succeed in taking a few of them
out.
Most of the law will stay in place. But Republicans
might be able to nibble around the edges. At the press conference
this week, President Obama indicated that he might be willing to
accept some changes to the law, so long as they didn’t impact
coverage. What sort of small tweaks might Republicans aim for? The
most likely item on the list is a repeal of the law’s medical
device tax, which is
opposed by many Democrats
—particularly those who represent
states where the medical device industry has a strong presence.
Republicans will try to make an issue out of the individual mandate
which is widely disliked, but Obama won’t let that one get through.
The employer mandate, however, might be a successful target: The
administration has delayed and undercut the provision on multiple
occasions, and liberal policy shops have argued that it’s not
necessary.

4) There are still more glitches to come. At
the press conference, Obama was adamant that the federal health
insurance exchange, which failed so thoroughly when it opened last
year, would work well. “We’re really making sure that that Web site
works super well before the next open enrollment period,” he said.
“We’re double- and triple-checking it.” There’s no doubt that the
exchange, the front end of which was reasonably functional by the
end of last year’s open enrollment period, will perform
significantly better when this year’s open enrollment period starts
later this month. But much of the back-end functionality—the guts
of the system—remains incomplete, and that’s going to cause some
problems. As The Wall Street Journal
reported
earlier this week:

Consumers who bought policies on the exchange for 2014
and switch to a different insurer for 2015 could end up enrolled in
two plans, with bills for both, in January, according to two
industry officials. Others who stopped paying premiums for their
plans this year could find themselves automatically re-enrolled in
those plans for 2015 regardless of whether they want them.

Meanwhile, lower-earning Americans who receive federal tax
credits to offset the cost of their coverage might not get a form
they need to file their 2014 taxes because the federal government
has an incorrect address for them, these officials say.

 These issues are likely to have an impact on tens of
thousands of people, according to the report, and some of them
won’t be apparent until tax time next year. Obamacare’s second open
enrollment period will be far smoother than last year’s, but it
will still be a bumpy ride.

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