Second round of enrolment begins under Affordable Care Act

Abstract

Federal health officials promise that last year’s embarrassing enrolment problems will not be repeated when the sign-up season begins on Nov 15 for 2015 health insurance policies off ered under the Aff ordable Care Act (ACA). But even as more insurance companies and millions more Americans enter the second year of the health insurance programme, the opportunity for critics to chip away at it will never be better when Republicans regain control of Congress in January. The presumptive Senate majority leader Mitch McConnell of Kentucky and John Boehner of Ohio, his House of Representatives counterpart, waited an entire day after their election victory this month to announce one of the fi rst tasks for the new Congress: a vote to repeal “Obamacare”. Never mind that President Barack Obama has said he would veto such legislation if it reached his desk. And most Congressional observers, irrespective of their political sympathies, predict that McConnell will be unable to muster the 60 votes needed to override the veto. Rather than take aim at the whole law, smaller targets might be vulnerable to attack with a well-crafted strategy that could very well be dispatched with a veto-proof majority. For example, repealing a tax on medical devices such as artifi cial hips has been gathering bipartisan support, which could deprive Obamacare of US$28 billion over the next decade if passed. A further delay of the requirement that employers provide workers with health insurance or pay a penalty also has support. Tucking some anti-ACA measures into the budget bill may also be effective since they would be packaged with things Democrats want so much that an Obama veto could be overturned. A big drawback to this scenario is all too familiar to long-time budget watchers such as Thomas Miller, resident fellow at the conservative American Enterprise Institute. Congress has to actually approve a budget. “It will take some time but it could be done by summer, and that’s on a good day”, he told The Lancet. “If you want to get rid of every tax and every provision you have to off set that with some spending measures [to save money] and that’s a little harder to do”, he said.