While Republicans cannot fulfill their campaign promise to repeal the new health care law any time soon, they can lead Congress in a sweeping re-examination of its more unpopular provisions, including new taxes and a requirement for most Americans to carry health insurance.
Joyful over Republican gains in the midterm elections, Representative John A. Boehner of Ohio, the man in line to become speaker, told reporters at the Capitol on Wednesday: “The American people are concerned about the government takeover of health care. I think it’s important for us to lay the groundwork before we begin to repeal this monstrosity.”
The election results promise a continuing battle over the health care law, not only on Capitol Hill but also at the state level, where many changes are scheduled to take effect in coming years. The partisan divide on this issue is likely to be a prominent feature in the run-up to the 2012 presidential election, perhaps making it more difficult for President Obama and the Democrats to secure broad public acceptance of the law.
The results will also probably complicate efforts to carry out the complex measure, which is expected to provide coverage to more than 30 million people by 2019. At a news conference on Wednesday, Mr. Obama delivered a stout defense of the health care law, saying, “This was the right thing to do.”
He acknowledged that the process of enacting it had been “an ugly mess,” and he said he would consider Republican ideas to modify the law, provided they “deliver faster and more effective reform” to the health care system. Mr. Obama mentioned one example, saying he would accept changes in a provision that imposes a huge information-reporting burden on small businesses. Under the provision, businesses would generally have to file 1099 tax forms identifying anyone to whom they had paid $600 or more for goods or services in a year.
James P. Gelfand, director of health policy at the United States Chamber of Commerce, said Wednesday: “I don’t think we’ll see a repeal of the health care law tomorrow. But I believe Congress got the message that we need serious changes. The question now is, what kinds of changes are realistic?”
A top priority, Mr. Gelfand said, would be to alter or eliminate a provision that will require many employers to contribute to the cost of coverage for employees. The requirement, he said, would hurt job creation and increase the cost of hiring workers.
Some labor unions may join employers in trying to roll back a new tax on high-cost, employer-sponsored health plans, scheduled to take effect in 2018. Several Republicans said they would try to reduce or repeal a new tax on manufacturers of medical devices.
Wall Street and many employers do not expect sudden changes. “Reform is here to stay,” said Andrew Webber, the chief executive of the National Business Coalition on Health, which represents employer groups that buy health care coverage for workers. Les Funtleyder, a portfolio manager and health care strategist at Miller Tabak in New York, agreed. “We place the chances of outright repeal at virtually nil, given the Democratic Senate and president,” he said in a note to investors on Wednesday.
But with Republicans winning control of many governors’ mansions and making gains at the state legislative level, they will be able to determine how the new law is carried out locally.
Republicans in Congress said they would try to give states more latitude and discretion on issues like the design of health insurance exchanges. The law calls for creation of an exchange in each state and says only government-approved insurance plans can be sold on the exchange.
The new rules, though stricter than in the past, may well be less stringent than they would have been if Democrats had not taken what Mr. Obama described as “a shellacking.” In addition, Republicans said they would try to cut the budget for federal enforcement of the law and related rules.
House Republicans said they would also try to reverse some of the law’s cuts in Medicare, particularly cuts in payments to Medicare Advantage plans run by private insurers, though they will be hard-pressed to find ways to offset the cost of such changes.
Republicans said they might agree to keep popular provisions of the new law, like protections for people with pre-existing medical conditions, while trying to scrap unpopular provisions, like the requirement for people to carry insurance. However, administration officials and insurance executives said such a combination would not work in practice.
