The 2014 election results will have an enormous impact numerous policy discussions, but none will feel as great an impact as Obamacare, which now faces new and unprecedented opposition and challenges.
The likeliest such challenge is a real vote to repeal and replace Obamacare, achieved through the tricky reconciliation process. That process requires only 51 votes, and the president would undoubtedly veto such a bill. But forcing him to veto it is key for many conservative groups, who will demand more than just a show vote blocked by Democratic filibusters.
The reconciliation process will play out in the spring of 2015, and after that the real negotiations will likely begin. There will be separate votes on the individual and employer mandates, on making the insurance risk corridors budget-neutral, and on smaller issues such as the medical device tax.
Medicaid Expansion Funding Cut?
But the real change here will be the opening of negotiations. With their new congressional majority, Republicans will finally be able to determine where President Obama is willing to negotiate, something he has avoided thus far thanks to the insulating efforts of Senate Majority Leader Harry Reid and the president’s use of executive actions to alter the law as he sees fit.
In the course of prior budget negotiations, the White House had indicated the president would be willing to increase the amount states have to pay for their Medicaid expansions, as one of the potential tradeoffs.
With Republicans holding ground in so many states that remain unlikely to expand Medicaid, the potential diminishing returns for avoiding such increases have decreased, and it’s possible this matching amount could change in the course of coming negotiations. That possibility could put fear into the legislatures in some states, such as Virginia, that expansion could end up costing them far more in matching tax revenue than current estimates indicate.
Time for Replacement Plans
Although it’s unlikely measures altering the work week requirements or the regulations and subsidies of Obamacare exchanges would survive a veto, it’s worth a try, and each step will likely attract some Democratic support. The real aim will be to force Democrats up for reelection in 2016 to stand by the law or break with their party.
Additionally, the time is now for Republican senators to offer replacement plans, some of which could be passed through the reconciliation process.
How much of the law will be truly repealed remains to be seen, of course, and expansion-minded Republican governors may force Senate Republicans to propose alternatives on the Medicaid front beyond mere block-granting. That will strengthen the president’s position.
All told, Republicans now have an opportunity to test the president’s devotion to his signature legislation. What has to stay, and what could go? They won’t find out until they begin pressing the issue, which for many of the newly elected Republicans is priority number one.