Ease Up on ACA Reporting

No one goes into business because they love paperwork. Well, OK, someone in the stationery business must be into it, but most people abhor it. Which is why it would be nice if Congress and President Barack Obama could come together to pass a bi-partisan proposal to amend the Patient Protection and Affordable Care Act with the Commensense and Verification Reporting Act of 2015.

The legislation was introduced in the House of Representatives as HR 2712 by Representatives Diane Black, a Republican from Tennessee, and Mike Thompson, a California Democrat. In the Senate the legislation, S 1996, is being put forward by Democratic Senator Mark Warner and Republican Rob Portman. Their goal, supported by over 175 businesses and associations, is to simplify the reporting employers need to support enforcement of the Affordable Care Act’s individual and employer mandates. Those regulations, promulgated by the Internal Revenue Service 2014, are quite burdensome and confusing–more than is required to achieve the purpose of the ACA.

The ACA tweak doesn’t do away with the reporting of information necessary to administer the health care reform law. The proposals simply streamline the process and reduce the burden. The proposal doesn’t undermine the individual mandate nor does it relieve employers from their responsibility to provide coverage or pay a fee to help offset their employees moving into the individual market. What it does do is make it easier for employers to comply with the ACA while still providing regulators the information they need to police the system.

This isn’t the first run at simplifying reporting under the ACA. Legislation similar to HR 2712 and S 1996 was introduced in the last Congress. That bill, S 2176, went nowhere. So is there any reason to believe this year’s attempt will fare any better?

Well, maybe. Yes, it’s true that any legislation aimed at improving the ACA has a rough road. Republicans want to kill the Affordable Care Act, not fix it. The House has tried to repeal or undermine the ACA so often pundits and the press have a hard time keeping a tally. No one in the GOP wants to face a primary challenge accusing them of being soft on Obamacare.

But, Congress has proven they can come together on simple fixes to the Affordable Care Act, especially if they help businesses. In 2011 Congress and the White House came together to remove expansion of the 1099 reporting requirement from the ACA. And this month they worked together in a bi-partisan fashion to allow states flexibility in defining what is, and is not, a small group.

It’s this last accomplishment — passage of the Protecting Affordable Coverage for Employees Act — that provides a glimmer of hope that maybe the Commensense Reporting and Validation Act of 2015 has a snowball’s chance of passage. Maybe.

It won’t be easy, however, and if it happens at all it will be next year. Congress’ s dysfunction has reached epic proportions as represented by the fiasco over electing a Speaker. Over the next several weeks Republicans will be consumed with getting their house in order (you’ll pardon the pun). Little time will be left for a full agenda of major issues touching on keeping the country out of default, avoiding a government shutdown, determining the fate of the Export-Import Bank, and more.

Getting any legislation through Congress during 2016 is problematic because it’s an election year. Elections distract lawmakers. They tend to focus more on scoring political points than addressing real problems. It’s a problem.

All of this means that proponents of HR 2712 and S 1996 will need to position their paperwork fix as a political win for enough candidates — I mean, members of Congress–to get them to pay any attention to it at all. If they are successful in this, however, the small amount of momentum generated by the recent passage of The Protecting Affordable Coverage for Employees Act may be enough.

Assuming members of Congress hate paperwork as much as the rest of us.

 

Health Care Reform is Coming, But it Won’t Be Easy

Personally, I think health care reform is inevitable. The need for change is simply too great. Too many people go without coverage, too many are insecure about the coverage they have. Controlling medical costs is a critical part of fixing the economy: businesses and state and local governments need relief. Political pressure for a solution — from across the ideological spectrum — has reached critical mass.

The reform process is well underway. President Barack Obama held a health care summit at the White House earlier this month. Several proposals are making the rounds. Senate Finance Committee Chair Max Baucus has one.  Senate Health, Education, Labor and Pensions Committee Chair Ted Kennedy and his staff have been actively meeting with stakeholders. Democratic Senator Ron Wyden and Republican Senator Bob Bennett have introduced the Health Americans Act, which is supported by several colleagues from both sides of the aisle. There’s the proposal put forward by President Obama during the campaign and embellished somewhat since his inauguration. Republicans have their plans and think tanks have theirs.

We’ve seen this before. In 1993 it looked like President Bill Clinton’s spent enormous political capital seeking health care reform. He failed. A recent Newsweek article by Katie Connolly outlined several reasons why the health care reform debate now is likely to be much different than the battles in 1993. The Clinton Administration failed in large part because their efforts were politically inept and inflexible. President Obama’s approach is much more open, inclusive and savvy.

Of course, at this stage we’re still dealing with generalities. The specifics, which is where the devil receives his mail, have yet to emerge.  When they do the hard part of the process begins. And that could be any week now.   The Washington Post’s Lori Montgomery and Ceci Connolly reported today that “House Democrats, in consultation with the White House, will give Republican lawmakers until September to reach a compromise on president Obama’s signature health-care initiative ….”  Currently, several committees in both houses of Congress are holding hearings on health care reform. These, however, are more educational in nature, allowing interested parties to provide input and begin staking out positions. With little legislation before them the hard negotiations have yet to begin. Those discussions will have to start sooner than later if Congress is to meet the House Leadership’s September deadline. Given the complexity of health care reform it will require months of negotiations to find common ground. 

Finding that common ground won’t be easy. Already Republican Leaders are identifying deal killers. A National Association of Health Underwriters’ newsletter quotes Senator Chuck Grassley, the ranking Republican on the Senate Finance Committee as identifying the Obama Administration’s call for a national health coverage exchange to compete with the private market as extremely problematic. The GOP won’t accept such a program, according to Senator Grassley, and Democrats are likely to insist on one. There may be a way to create an exchange that satisfies both parties, but that requires a lot more specifics than have emerged yet. 

(Note added 3/20/09 at 7:45 pm: the rift between Senator Grassley’s position and those favoring a government insurance plan is growing wider — and nastier. Carrie Budoff Brown, writing in Politico today, reports on “a four-day ad buy aimed at Iowa Sen. Charles Grassley, the ranking Republican on the Senate Finance Committee who is increasingly vocal in his opposition to the government insurance option.” Health Care for America Now is leading the charge against Senator Grassley. At the White House Forum on Health Care the ranking Republican on the Senate Finance Committee told President Obama that such exchanges were “‘an unfair competitor’ and could run private insurers out of business,” according to the Politico story. The article also notes that Senator Wyden found no Republican Senators willing support his bipartisan legislation if it included a government run health plan. “From a raw political standpoint, having talked to a lot of senators, I wouldn’t have any Republicans on the Health Americans Act as cosponsors if we had a public option,” he told Politico.)

There is a way for Democrats to pass health care reform without Republican votes. If a compromise fails to emerge by September, the House Leadership is pushing for a legislative process that would allow passage with simple majorities in both chambers. This would be accomplished through a process called “budget reconciliation.” Under the reconciliation rules, filibusters are not permitted enabling the Senate to move legislation forward with a simple majority of 51 votes instead of the 60 needed to end a filibuster. Democrats currently hold 58 seats in the Senate (including those of two independents who caucus with them) with one more likely to arrive from Minnesota. (Filibusters don’t exist in the House, making passage by majority vote the norm in that chamber).

But Democrats may have a tough time pulling together even 51 votes in the Senate. Senator Evan Bayh announced on MSNBC on Wednesdaythat 16 moderates in the Senate (15 Democrats and one independent who caucuses with the party) have come together to provide a united, centrist voice to issues such as health care reform. As noted in the press release announcing the group’s formation, their goal is “to pursue pragmatic, fiscally sustainable policies across a range of issues, such as deficit containment, health care reform …” and others. With 16 members, this caucus, currently dubbed the “Moderate Dems Working Group” represents more than a quarter of the Democrats serving in the Senate. If even 10 0f these centrists stick together they’ll need to be a part of any deal struck on health care reform.  (A list of the 16 Senators in the group is below).

At the same time there are liberals in Congress who would just assume have government take over the health insurance industry and create a single payer system similar to that in place in Canada and many Western European countries. At the very least they look to a greater role for the government in providing health care coverage to middle class Americans (the government is already the primary insurer for older and low income citizens).  They won’t go quietly along with a solution they feel fails to assure universal and comprehensive  coverage.

What this means is that while health care reform is coming, getting there won’t be easy. But there is a way. President Obama has long talked of the need to focus on core principles and the desired outcome instead of on how we get there. He has even said that his campaign proposal for a federal health insurance exchange (the deal breaker identified by Senator Grassley) is negotiable. As noted in the Newsweek article, the president said at  the White House summit, “If all Americans could be insured at ‘an affordable rate and have choice of doctor, have flexibility in terms of their plans, and do that entirely through market, I’d be happy to do it that way.'”

This is the approach all lawmakers and interest groups — whether liberal, moderate and conservative — need to bring to the table. The health care reform debate will be heated, passionate and difficult. But if all participants focus on the goals, the means of getting there can be found.  Given the need, it better be.

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The 16 members of the Moderate Dems Working Group (who, hopefully, will work on coming up with a better name) are:

  • Evan Bayh (Indiana) – co-chair
  • Mark Begich (Alaska)
  • Michael Bennet (Colorado)
  • Tom Carper (Delaware) – co-chiar and a member of the Senate Finance Committee*
  • Kay Hagan (North Carolina) — a member of the Senate H.E.L.P. Committee*
  • Herb Kohl (Wisconsin)
  • Mary Landrieu (Louisiana)
  • Joe Lieberman (Connecticut)
  • Blanche Lincoln (Arkansas) – co-chair and a member of the Senate Finance Committee*
  • Clare McCaskill (Missouri)
  • Ben Nelson (Nebraska)
  • Bill Nelson (Florida) — a member of the Senate Finance Committee*
  • Mark Pryor (Arkansas)
  • Jeanne Shaheen (New Hampshire)
  • Mark Udall (Colorado)
  • Mark Warner (Virginia)

* The Senate Finance Committee and the Senate Health, Education, Labor, and Pensions (H.E.L.P.) Committee have primary jurisdiction over health care reform legislation.