Massachusetts Medical Society: Republican Congress in 2015: What Does It Mean for Health Care?

Republican Congress in 2015: What Does It Mean for Health Care?

ACA, Medicare Expected to be Targets


The Republicans trounced the Democrats in the November midterm elections and picked up more seats in the House and the Senate than most experts predicted. They made President Barack Obama the focus of their strategy, and it worked.

But now the real question is what does this mean for the 115th Congress? Republicans are in the majority in both chambers, but they most likely do not have enough votes to override a presidential veto. Republicans will now assume the chairmanship of all Senate committees, and they will have more members on each committee. And as the majority party in each chamber, they will set the Congressional agenda. But what can they get done?

The Republican conservatives, who will feel empowered by the election, will push for a full repeal of the Affordable Care Act (ACA) — the legislative piñata of the Republican Party. But without the votes to override an Obama veto, any attempts will fail. Republican leaders in the Senate have already said they will go for some incremental changes, such as repealing the medical devices tax and repealing the Independent Payment Advisory Board, which was empowered to make cuts to Medicare should spending increase beyond targets.

Should they succeed in this effort, expect other industries taxed as part of the ACA to come to the table. The problem with this strategy is that these tax dollars are a very important funding source for the ACA. Other provisions on the Republican hit list, including repealing the individual mandate, are less likely to succeed.

In terms of health care, the biggest changes may come to Medicare via a “reconciliation” bill, which will attempt to cut the costs of social programs like Medicare and ease the passage of a simplified tax code.

Should Rep. Paul Ryan take over the House Ways and Means Committee, we would also expect a renewed push to transform Medicare into a premium support program which was one of the hallmarks of his vice presidential campaign. Republicans will also have an opportunity to make significant legislative changes through appropriations bills.

Whether Washington will become any more productive than it has been probably rests on what each party sees at its best strategy for 2016. Now that the Republicans are the majority in both chambers, will they be held responsible if DC continues its gridlock and face ballot box defeat in 2016? Will the Democrats want to find compromises with the Republicans in light of the upcoming presidential election in 2016? And how will the GOP balance the demands of its conservative arm particularly in light of presidential election where the electorate is much more diverse? We will be watching all of this very closely in the coming months.

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