GOP Bracing for Fight as Major Obamacare Laws Take Effect

The newly Republican-controlled House will face a massive task immediately when it gets to work in January. Major planks of Obamacare — the nation’s new healthcare law — go into effect on Jan. 1 even as the regulations are being challenged by Republican-dominated state legislatures in a federal lawsuit.

Some of the law’s biggest provisions — including the requirement that everyone buy insurance, the state insurance exchanges, and subsidies to help most Americans buy insurance — don’t begin until 2014. But more than 20 elements of Obamacare go into effect in 2011, according to a Kaiser Family Foundation timeline, The Hill reports.

Many members of the new tea party-dominated House and Senate GOP are seeking to repeal Obamacare completely, but that’s nearly impossible with President Barack Obama still in the White House and Democrats still holding a small majority in the Senate.

So Republicans will try to withhold funding for the new law, beating it back one appropriation at a time. Democrats will fight these moves, of course. And making the GOP effort more difficult is the fact that Democrats frontloaded the law with several consumer-protection related provisions many voters support, according to polls.

The administration also faces a host of bad news regarding implementation of the plan. States are reporting minuscule interest in high-risk pools being set around the country. With few people enrolling, premiums actually are climbing so high that others don’t want to enter the programs, The Washington Post reported this week.

Editor’s Note: See “Obamacare Program for Uninsured Failing in Many States.”

The Obama administration also is trying to quiet talk about so-called “death panels” after The New York Times reported Sunday that a new Medicare regulation includes incentives for end-of-life-care planning.

The Medicare policy will pay doctors for holding end-of-life-care discussions with patients, according to the Times. A similar provision was dropped from the new healthcare reform law after former Alaska Gov. Sarah Palin and other Republicans accused the administration of withholding care from the sick, elderly and disabled.

Editor’s Note: See “Obama Embraces ‘Death Panel’ Concept in Medicare Rule.”

Public support, meanwhile, for a key element of the healthcare reform law is slipping after a federal judge ruled the provision is unconstitutional, according to a poll released Monday.

A CNN/Opinion Research poll showed that only 38 percent now favor language "requiring all Americans who do not have health insurance to get it." Support fell six points from August, when it was at 44 percent, The Hill reported. Opposition to the provision has risen to 60 percent from 56 in August. Support for the individual mandate was at a high in November, when 49 percent said they backed it.

The poll comes after a Virginia federal judge struck down the provision, dealing the Obama administration's healthcare law its first major defeat in the courts.

Experts expect the dispute to reach the Supreme Court; two previous challenges to the mandate were defeated in Virginia and Michigan by judges President Bill Clinton appointed.

Some of the changes that begin next year are popular, such as a requirement for healthcare plans that spend less than 80 percent of premiums on healthcare services to provide rebates to customers.

But Obamacare is none too popular overall, as was proved by Republicans’ smashing victories in last month’s elections.

Here are major changes that begin Jan. 1, according to The Hill.

• Medical-loss ratio requirements: Healthcare plans must return money to customers if they spend less than 80 percent of premiums on health care.
• Closing the doughnut hole: Medicare beneficiaries will obtain a 50 percent discount on brand-name prescriptions, as the government fills in the Medicare Part D "doughnut" hole. The "doughnut hole" refers to a gap in Medicare prescription drug coverage included in the 2003 law that created the program.
• Primary care bonus: Doctors will get a 10 percent Medicare bonus for primary care services, while general surgeons in health professional shortage areas will also receive a 10 percent increase. The temporary bonuses last through Dec. 31, 2015.
• Medicare prevention benefits: Cost-sharing for Medicare-covered preventive services earning an "A" or "B" grade from the U.S. Preventive Services Task Force will cease.
• CLASS Act: A national, voluntary program will permit workers to buy long-term care insurance.
• Premium threshold freeze: The income threshold for income-related Part B premiums will be frozen at 2010 levels for 2011 through 2019.
• Medicare Advantage changes: Payment rates to private Medicare Advantage plans will be cut gradually compared to Medicare fee-for-service rates.
• Health home payments: States can let Medicaid enrollees choose a home healthcare service as their provider, and states can receive 90 percent federal matching payments for two years for home health-related care.
• Chronic disease prevention: States can garner three-year grants to develop comprehensive health lifestyle programs for Medicaid enrollees.
• Tax-free spending accounts: Costs for over-the-counter drugs not prescribed by a doctor won’t be reimbursed through a health reimbursement account or flexible spending account.
• Quality strategy: The Department of Health and Human Services must report to Congress a strategy to improve healthcare service delivery, patient health outcomes and population health.

Democrats plan to use the repeal debate to detail what they call the law's benefits, while simultaneously attacking Republicans for wasting time — and money — refighting old battles and pushing back on court rulings against it.

Ways and Means health subpanel Chairman Pete Stark, D-Calif., unveiled a 14-page report last week to help Democrats hone their arguments against repeal. It’s a compilation of the law's benefits, such as subsidies for most people to buy insurance and the requirement that insurance plans cover even people with pre-existing conditions.