There are two health care-related sideshows playing out in Washington. One is a semantic argument about whether the fine for not having health insurance under Obamacare is a “penalty,” as the law’s author’s originally claimed, or a “tax,” as Supreme Court Chief Justice John Roberts ruled last month. The other is a House Republican attempt to immediately repeal the health care law, which is scheduled to get another vote this week. Neither of these debates has any consequence. In fact, they’re obscuring the real reasons the Affordable Care Act’s future is still incredibly uncertain, even after the High Court’s decision to uphold the law.
If Mitt Romney is elected President and Republicans emerge from this year’s elections with majorities in both houses of Congress, most experts agree that they could repeal huge swaths of the health care law via reconciliation, the parliamentary process that allowed Democrats to push health care reform over the finish line in 2010 without a supermajority in the Senate. As Politico reports (subscription required), GOP staffers on Capitol Hill are currently studying exactly what pieces of the law could be subject to change through reconciliation.
Congressional rules say the process can only be used for legislation that affects the federal budget and lowers the deficit, but that applies to much of the ACA. Subsidies created by the law to help low and middle-income Americans buy insurance outside of work could be vulnerable, for instance, even if Republicans can’t repeal the whole law, which the Congressional Budget Office says reduces the deficit. The loss of those subsidies could seriously imperil the affordability of insurance and the effort to pull currently uninsured Americans into the coverage market.