Though efforts to repeal the Affordable Care Act have continually been unsuccessful, the omnibus spending bill just signed by the president shows that ACA opponents are likely to have more luck targeting smaller chunks of the law, according to the Associated Press.
The $1.1 trillion spending bill and accompanying tax extenders package delays the Cadillac tax by two years, suspends the medical device tax through 2017 and delays the fee on health insurers for one year.
Some analysts have pointed out that those tweaks stop far short of dismantling the core of the ACA. Indeed, Paul Van de Water of the Center on Budget and Policy Priorities, which advocates for low-income individuals, told the AP that the tax delays are "not a blow against the ACA at all."
But Joe Antos of the right-leaning American Enterprise Institute told the AP that most Republicans have probably accepted the fact that "simple repeal is not possible" given how long the law has survived. The budget deal could pave the way for more small-scale changes to the law, perhaps starting with the employer mandate, he added.
The employer mandate has critics from both major political parties, the AP notes, as did the Cadillac tax that would have set a 40 percent levy on certain high-cost employer-sponsored health plans. To execute the delay of that provision, according to The Hill, high-ranking Democrats Nancy Pelosi and Harry Reid had to conduct "secret budget talks" with GOP leaders while also negotiating with the White House, which has steadfastly opposed repealing the tax.
Lawmakers have been able to make other small-scale changes to the ACA, the AP points out, including halting the expansion of the definition of the small-group market, limiting the government's ability to make payments to insurers through the risk corridor program, changing an income formula that determines Medicaid eligibility and repealing a long-term care insurance program.
The Senate also passed a bill to repeal large swaths of the ACA in early December, though it is sure to be vetoed by the White House. Some though, think it could pave the way for a repeal if a Republican becomes president.
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