If you’re a federal lawmaker, you have a love-hate relationship with the Affordable Care Act.
Generally speaking, if you’re a Democrat, you love it. If you’re a Republican, you hate it.
The most politically divisive law in recent history is set to begin Oct. 1, when people can begin to sign up on the health insurance marketplace for benefits that will kick in Jan. 1, 2014.
But as the landmark legislation that passed without a single GOP vote moves forward, Republicans continue to pounce on problems that have arisen with a “repeal and replace” mantra for the ACA — often called “Obamacare.” Meanwhile, Democrats try to troubleshoot mistakes and avoid their opponents’ political fire.
“You can’t just be in the ‘it’s perfect, don’t touch it’ caucus or the ‘repeal and walk away’ caucus,” said Pennsylvania Democratic U.S. Sen. Bob Casey, a supporter of the law. “Health care should be a bipartisan concern. This was not a perfect bill, but it does help millions of Americans, and I think over time, it’s going to reduce costs.”
About 25 million people are expected to enroll in the health insurance exchanges (now known as marketplaces) by 2018, according to the Congressional Budget Office.
Casey’s been pragmatic in attempting to “fix” the parts of President Barack Obama’s signature health care law that he sees as problematic.
One example is legislation he helped introduce to repeal the 2.3 percent medical device tax, pegged to raise $30 billion over 10 years by taxing companies that make or import medical devices. He said that tax “would hinder industry innovation, job creation and the overall delivery of quality patient care.”
Republicans contend the whole law fits that description, and have jumped on several of its missteps, including the immortal words of then-House Speaker Nancy Pelosi, who said in the weeks before the ACA became law: “We have to pass the bill so that you can find out what is in it.”
The ACA “is a complete unmitigated disaster,” said Pennsylvania Republican U.S. Sen. Pat Toomey. “It’s becoming increasingly obvious that it’s hopelessly and irreparably flawed.
“From the start, the process was horrendous,” Toomey added. “They jammed this through late at night with a draft that wasn’t complete. To have such a sweeping overhaul of 16 percent of our economy without broad bipartisan support was a bad idea.”
Toomey, who agreed with Casey on repealing the medical device tax, said Bucks and Montgomery counties are home to a “robust manufacturing sector” that would be hurt by the device tax. “We see very specific real life examples of how problematic this is.”
He outlined other problems he sees with the ACA, including the administration’s admission that the part requiring companies to provide coverage for workers was too complicated. The administration delayed that so-called employer mandate until after the 2014 elections.
The costly 1099 reporting requirement for small businesses was among the House’s 40 repeal votes, most of which were dead on arrival in the Democratic-controlled Senate.
And in recent weeks, unions have been organizing against “Obamacare,” a term first used derisively by opponents but one even the president has embraced. Labor groups claim the ACA undercuts existing health insurance plans and encourages employers to cut workers’ hours below 40 per week.
“Large labor unions were the president’s strongest allies and this is disastrous for them,” Toomey said.
The greatest concern for Congressman Pat Meehan, R-7, is the security of the federal health care exchanges, which he said will house “the biggest and greatest collection of private information that has ever been put together on American citizens.”
Government agencies have missed several deadlines in security testing for the data system, leading him to introducea bill to delay the online databases from going live.
Meehan, chairman of the cyber security subcommittee, said, “I have seen what can happen with cyber espionage. We are dealing in real time with very dangerous people in the world who want to do us harm. It’s entirely foreseeable that this type of system could be vulnerable.”
Congresswoman Allyson Schwartz has been a key proponent of the ACA, but has also spoken out against the Independent Payment Advisory Board and medical device tax.
“Any legislation as significant as this is going to have to be amended at some point,” she said. “There have been several changes made to Medicare over time. It’s about being responsive to how this works in the marketplace and in people’s lives.”
While lawmakers battle over the law, polls have been fairly consistent since the ACA was enacted in 2010.
Last month, the Kaiser Family Foundation showed 42 percent of people surveyed have an unfavorable view of the ACA, while 37 percent like it. Those numbers haven’t strayed much in three years.
On the other hand, the voting public has sent mixed messages at the ballot box.
In 2010, voters took the gavel from Pelosi and ushered in a Republican House that picked up 62 seats after the president spent much of his first year in office plotting out health care reform. Since then, the U.S. Supreme Court has ruled the ACA is constitutional, the GOP has lost seats in the House, and Obama was re-elected.
Whether in Washington or the state Capitol, the battles continue.
The ACA “provides the opportunity for Americans who have been uninsured or have very poor insurance to purchase a quality plan,” Schwartz said. “It is unconscionable that this is not being encouraged across the board.”
Casey, whose father was Pennsylvania’s governor from 1987 to 1995, said his dad had a saying: “What did you do when you had the power?”
When Republicans had a GOP president and majorities in both legislative branches of government, “the result was a big goose egg, a big zero,” Casey said.
He chided the GOP “repeal and replace” talk as “repeal and walk away.”
“They want to go back to the dark days, when it was tolerated to deny a child with a pre-existing condition coverage,” he said. “These are children with coverage whose parents were paying premiums but the insurance companies had absolute power.
“They want to say ‘good luck, you’re on your own.’ That was a moral blot on our country,” said Casey. “Thank God we got rid of that.”
Fitzpatrick said he has “a better idea (in response to) the American people’s demand for a better way.”
He has introduced legislation with Nevada Republican Congressman Joe Heck to continue the popular consumer protections of the ACA even if the law was repealed. Those protections include keeping children on parental insurance plans until the age of 26 as well as covering people with pre-existing conditions.
The Ensuring Quality Health Care for All Americans Act of 2013 would “repeal the onerous taxes and mandates of Obamacare,” Fitzpatrick said. “I think it makes sense. It does what the ACA does not do, which is contain costs.”