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Democrats' Confidence in Health Care Law Grows, Though Many Still Back Fixes

By Melissa Attias and Emily Ethridge, CQ Roll Call

January 16, 2014 -- Congressional Democrats who suffered through the vexed rollout of the health care law's federal exchange late last year are feeling more optimistic, now that many initial website problems have been resolved by the Obama administration and enrollment numbers are growing.

But many Democrats also continue to work on finding fixes and improvements for the law, and some support Republican bills that would, for example, enhance the security of personal information provided to the exchange or delay penalties for not buying insurance.

The outlook is not bright for tinkering, though. Although rank-and-file Democrats may say they want to implement changes, Democratic leadership in both chambers has continued to oppose Republican attempts to alter the law. Lacking leaders' backing and the support of the White House, any legislation has slim chances of making it past the finish line.

With more than two months left of open enrollment in the law's exchanges, most Democrats say they support the overhaul and tout its progress—while also keeping an eye out for additional problems that are bound to crop up as millions of Americans begin to use their new health insurance.

"We're on the beachhead at Normandy. And it was a lot of concern that we weren't going to make it through," said Rep. Jim McDermott, D-Wash. "Now you're going to find a new set of problems as it goes into operation."

McDermott added, "We knew if we could get on the beach, we would—now we gotta take France and Germany."

When it comes to changes, though, congressional Democrats are divided about what—if anything—should be done. The stakes for Democrats may be especially high this year as lawmakers face the first congressional elections since the troubled rollout of the federal insurance exchange.

While their Republican colleagues continue to send out wave upon wave of press releases slamming the overhaul (PL 111-148, PL 111-152), Democrats are not as outspoken in their support—although many are highlighting the improved enrollment numbers and website functionality.

For their part, Republicans are planning to make the most of any vulnerable Democrats' support of the law. The Republican National Committee announced earlier this month that it was launching a radio ad campaign focused on Democrats "who lied to voters by telling them they could keep their healthcare plans under ObamaCare," according to a release.

"It's not possible for this not to be the No. 1 issue going into the 2014 elections—it's just not," RNC Chairman Reince Priebus said on a Jan. 7 conference call.

But many Democrats believe with website improvements, more people will gain benefits and have a positive experience with the law. McDermott and Jan Schakowsky, D-Ill., both noted how the enrollment process has recently improved in their states' exchanges.

"I'll tell you, since Jan. 1 it's been pretty good in our office," Schakowksy said.

Although the overwhelming majority of Democrats have voted against repealing the overhaul, a number of them have backed bills that would deal with possible security problems in the federal exchange website and expand access to plans and providers.

Sixty-seven House Democrats voted on Jan. 10 for a bill (HR 3811) that would require the administration to notify individuals within two days if their personally identifiable information has been compromised during a security breach of the exchange website. That's considerably up from the 39 Democrats who voted for a measure (HR 3350) in November that would allow insurers that provided coverage in the individual market as of Jan. 1, 2013, to continue to offer that coverage in 2014 outside of the insurance exchanges.

Rep. Ron Barber, D-Ariz., who supported both those bills, said he still has a lot of concerns about the security of the website. He introduced legislation (HR 3847) that would require the Department of Health and Human Services to comply with cybersecurity standards set by the Department of Homeland Security to ensure the privacy of information.

Barber said he might also offer the measure as an amendment to a larger cybersecurity bill the House Homeland Security Committee will consider in the next few months. But he said he supports moving forward with the law.

"I don't want to throw the good things out with the bad. I'd much rather fix the things that don't work," he said.

Barber said he would continue to vote "on principle" when it comes to the health care law, even though he got some pushback from constituents after supporting GOP bills to delay the law's individual mandate (HR 2668) and the employer mandate (HR 2667).

"A lot of Democrats were very upset about—back home—upset that I somehow deserted the ACA," he said. "For me it was a matter of principle."

In the Senate, Tim Kaine of Virginia expects to continue to have discussions with an informal group of lawmakers from both parties who are interested in making improvements to the law. He said he had talked with between 12 and 20 members of Congress.

"I just think every day there is more of a reform constituency," he said.

West Virginia Democratic Sen. Joe Manchin III is one of those who believe implementation should continue but that Congress should respond to any problems. He mentioned his bill (S 1671) with Illinois Republican Sen. Mark S. Kirk to delay the law's penalty for a year for those without individual insurance coverage.

"If it doesn't work, in certain parts of it, then you have to move. And that's a transitional year without any fines or crimes applied to it," he said.

McDermott also has introduced two bills that he said would make small technical fixes to the law. One (HR 3833) would allow nurse practitioners, physician assistants, and clinical nurse specialists to certify face-to-face encounters with beneficiaries to verify eligibility for Medicare home health services. The other (HR 3832), he said, would close a loophole to help stop waste, fraud and abuse.

Not all Democrats, however, see the need for additional legislation. Schakowsky said that cooperation from pharmacies and insurance companies has helped smooth over some enrollment issues. "I think that to somehow do a legislative fix at this point would be at worst premature and at best not really necessary," she said.

McDermott said that although Republicans may try to continue their efforts to repeal or dismantle the bill, Democrats would defeat them. "We're on the beach. They ain't gonna throw us off," he said.

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