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Five Factors That Could Affect Obamacare in the Future

Posted on December 10, 2012 by admin

With the second open-enrollment period underway, citizens across the country look to the future and consider the changes in store for Obamacare. Even four years after the implementation of the Affordable Care Act, factors continue to cause adjustments to the healthcare law. The following five elements have a chance of causing their own changes, both incremental and extreme.

1) Repeal remains unlikely.

The new Senate Majority Leader Mitch McConnell (R-Ky.) recently acknowledged that Republicans most likely do not have the 60-vote majority necessary to fully repeal the bill. McConnell has also said that a presidential signature would be necessary for this bill to be repealed, and President Obama has vowed to veto any such request.

In this sense, Obamacare should have a steady presence until after the next presidential election, at least. However, multiple factors could still change its structure and impact.

2) Courts can still adjust the ACA’s parameters.

Currently, the Supreme Court is ruling on the meaning of the phrase, “established by the state,” as it relates to tax credits and subsidies. As of now, the federal government is providing subsidies to states that did and did not establish their own health insurance exchanges. Conservatives are arguing that only the states that established these exchanges should receive subsidies. The Supreme Court’s ruling could decide that this is not implied in the Affordable Care Act, and is thus unlawful. The result would be the removal of subsidies from millions of Americans in need.

3) Medical device tax faces repeal.

One of the key ways in which the Affordable Care Act has raised funds for credits and subsidies is by levying a 2.3 percent tax on the sale of medical devices. The federal government may have to find another source for fundraising, as this law has already been pushed toward repeal on multiple occasions. In addition, the medical device tax has bipartisan opposition, and the Obama administration has acknowledged the possibility of repeal if Congress presents a viable alternative for raising funds.

4) Conservatives want to raise the work hours required for employment-based coverage.

Another way that Obamacare will be tested concerns the GOP’s push to redefine the work week necessary to require employers to provide health insurance. Currently, 30 hours is enough to require business owners to provide employment-based insurance to their workers. Republicans want the hour requirement raised to 40, which studies indicate would result in one million Americans losing coverage. These Americans would then have to search for coverage through private providers or the Health Insurance Marketplace.

5) Medicaid expansion is being stalled.

With states that feature the most Medicaid-eligible individuals voting against candidates in favor of expansion (such as Florida, Georgia, Kansas and Texas), the Affordable Care Act’s reach is being limited. Whereas the law originally involved the expansion of each state’s Medicaid program, the Supreme Court’s ruling determined that the states needed to approve of the expansion. The result has been that only 27 states and the District of Columbia have accepted the offer, with improved care being refused by 23 states.