Changes to ACA could come quickly with new Congress

Mar 13, 2017

By Tonda Rush
Public Policy Director | NNA

WASHINGTON—Revisions of the Patient Protection and Affordable Care Act, otherwise known as Obamacare, are slated for fast-track consideration in the 115th Congress.

President Donald J. Trump made repeal and replacement of the ACA a key issue in his campaign. House Republicans have already voted more than 50 times in previous Congresses to repeal it. However, the “replace” option is proving trickier than Republican leadership expected.

Small businesses with fewer than 50 employees are exempt from employer mandates in ACA, thanks to the work of National Newspaper Association and other small business groups, when the law was passed. But many newspapers have helped staff to sign up for personal policies through state or federal policy exchanges. NNA in February began an all-member survey to gather views about the replacement model for ACA. The NNA board is scheduled to review the feedback in March.

Highest priority for NNA members responding as of late February was to include a requirement for policies to cover pre-existing health conditions. Nearly two-thirds of respondents ranked the requirement as top priority.


Other concerns

• Making sure children under age 26 can be on parents’ plans.

• Eliminating the 3.8 percent tax on investment income that helped to pay for ACA.

• Eliminating mandates on companies to provide health plans.

In general, some community publishers—about 45 percent—favored getting the federal government out of the health insurance markets, although a little more than one-third favored a single-payer federal system. Such are the complexities of finding a national consensus on repeal-and-replace.

Nonetheless, Sen. Lamar Alexander, R-TN, chair of the Senate Health Education Labor and Pensions Committee, has begun work, focusing initially on ways to stabilize individual insurance offerings. Major underwriters in his home state have pulled out of the individual market, the latest being the Humana group. Alexander has called the situation “an emergency.” But he has described the struggles between Republicans and Democrats on resolving ACA disputes for the past six years as akin to the battles between the Hatfields and McCoys.

“I know it is not easy to move from Hatfields and McCoys to working together on this issue,” he said during a February hearing, “but if there is one area where we ought to be able to do that, it is with the individual market and the problems we have with it.”

The House Energy and Commerce Committee has also begun hearings on replacement models. Rep. Greg Walden, R-OR, has introduced a bill requiring the replacement model to cover pre-existing conditions, and focus on the individual policy market is a priority in the House, as well.

The rewrite faces several hurdles. In general, the GOP would prefer to focus on tax credits and allowances, such as enhanced Health Savings Accounts and elimination of taxes on businesses, and returning regulation to the states with some form of funding. However, repeal bills affect the federal budget deficit by repealing tax revenue. And replacement to cover costly riders like pre-existing condition coverage generally faces opposition from insurance companies unless the unpopular mandates for every person to have insurance are maintained.

House Speaker Paul Ryan, R-WI, pledged that a consolidated replacement plan would be introduced following Congress’ Presidents Day recess, which ended Feb. 27.

NNA President Matthew Paxton IV, publisher of The News-Gazette in Lexington, VA, said his board would closely follow the progress.

“In general, we get involved only in issues that affect community newspapers. This legislative initiative affects all small businesses, potentially, so we will be keeping a close eye on it and seeking member views. During the initial ACA passage, we had no broad industry consensus on the complex and multiple provisions in the bill, but we were concerned about avoiding punitive new mandates on small businesses that would require them to find group health plans. We were successful in that. But our newspapers and their employees have been affected by ACA as it has rolled out.

“We may not take a position on a total replacement plan this year either,” he said. “But we have an obligation to keep our eyes open for things that would be uniformly harmful or unquestionably beneficial. This Congress has the opportunity to present some or all of these impacts. We will definitely be on the watch.”