After the Mid-Term Elections...What Next for "Obamacare"?

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There seems to be a concensus of opion that there was never a chance that Republican mid-term victories - even under the most optimistic projections - would or could unravel the health care reform law.   Even if the Republicans had managed to capture both houses of Congress, the health care reform law was in no danger of repeal.  Any attempt by Congress to repeal the bill would be vetoed by President Obama, and the Republicans lack the 67 Senate votes necessary to override a Presidential veto.

If the GOP cannot outright eliminate the law, can they render it powerless by denying it funding?  The law mandates federal funding of more than 100 key components of the bill, most notably grants to states to establish insurance exchanges by 2014 as well as the $500 billion necessary to provide subsidies toward individual purchases of insurance in the exchanges.  Federal taxpayers are also picking up, for the first several years, nearly all of the additional Medicaid expenses associated with the expansion of Medicaid eligibility.

Holding up the federal budget by threatening the shutdown of the government is a very risky tactic for the GOP to pursue.  Many voters are weary of partisanship and are expecting Congress to make something good happen...the American electorate wants results.

It seems that some minor "revision" around the softest edges of the health care reform bill is likely.  The business community is appalled at the new Form 1099 reporting requirement appended to the law.  This requirement compels businesses to issue a Form 1099 to every vendor from copy repairmen to bartenders - to whom the company pays $600 or more during a year.   House Republicans will likely attract enough Senate Democrats to repeal that provision. 

There has been some speculation of an attempt to repeal the "Free Rider Surcharge" of the bill - i.e. the penalty employers will pay beginning in 2014 if they fail to offer affordable coverage to full-time employees who instead obtain subsidized coverage in the insurance exchanges.  Business has many justifications for opposing the Free Rider Surcharge.  However, if the insurance exchange concept survives until 2014 and employers find that their employees have another, taxpayer-subsidized option for health coverage available, a great many employers may simply terminate their group coverage.  Although this will undoubtedly improve the business' bottom line, it could be disastrous for the nation's.

The Congressional Budget Office - in its estimation of the first decade's cost of the bill at $1 trillion - assumed only about 4-5 million Americans who have insurance today will lose it by 2019 as a result o the health reform law.  One recent study suggested that the cost of federal subsidies in the insurance exchanges rises about $300 billion for every additional six million Americans who seek exchange-based coverage.  If the 4-5 million person estimate balloons to 40-50 million, the first decade's costs of the program skyrockets to $2.5-$3 trillion, a number that is simply not sustainable.

We shall see.