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Don't Look for Health Law Changes Before 2017, Policy Experts Say

By Kerry Young CQ HealthBeat Associate Editor

November 22, 2013 -- Congress will eventually make some adjustments to the 2010 health law, but these won't happen until at least after the next presidential election, health experts recently said.

Some alterations to such sweeping legislation (PL 111-148, PL 111-152) are virtually inevitable, although its substance will be left intact, agreed members of an American Enterprise Institute (AEI) panel. They included Ron Pollack, executive director of the left-leaning advocacy group Families USA; Gail Wilensky of Project Hope, who ran the Medicare and Medicaid programs during the George H. W. Bush administration; and Joseph Antos, the AEI panel who chaired the panel.

"This legislation is not going away," Wilensky said. "It has problems that at some point we'll start to get refocused on, and deal with."

For the immediate future, though, there is little chance of Congress clearing any major tweaks to the law, said Wilensky, now a senior fellow at Project HOPE.

The odds for a fix of any kind before 2016 were low even before Senate Majority Leader Harry Reid, D-Nev., has exercised what had long been called the nuclear option, but that decision pretty much took any quick fixes off the table, she said. The Senate voted to require only a simple majority, rather than 60 votes, to overcome filibusters on executive branch and judicial nominees, other than for the Supreme Court. This enraged Republicans, and thus will make it more difficult to pass complex legislation, such as any changes to the health law, she said.

"I am now more convinced than ever it will be not until after 2016," Wilensky said, saying that Reid's move "irreparably poisoned" the atmosphere on Capitol Hill. "There is now no chance of a coming together to try to make things better until there is another presidential election."

Among the health issues likely to confront the next president will be any fallout from an expected major shift in how people with moderate wages get their insurance. Many companies that don't have to compete heavily for employers and thus pay lower salaries will stop providing health coverage, and shift their workers to the exchanges, Wilensky said.

"Both the employee and the employer are better off because the subsidy is more" in cases where smaller companies have not been providing highly generous packages, Wilensky said. She was referring to subsidies people below certain income levels get to buy health coverage on exchanges.

"Big employers aren't likely to move. They are already set up to attract well skilled employees" through more generous benefit packages.

There could be big migration away from what's now the common model of health insurance being tightly linked to employment, but this will take time, she said.

"This isn't going to happen in the first year. This is a like a five-year phenomenon," she said.

Antos said it's difficult to predict what health issue the next administration will address first. But it could be revisions to the law stemming from wider-than-expected switching into new kinds of health exchanges as smaller companies drop coverage. "Suppose employers embrace private exchanges in a big, big way, which I think they will. This is what happened with pensions," Antos said, referring to the 1990s move toward broader use of 401(k) plans. "Then I could see some regulation to provide a little more protection, just like what happened with pension plans going to 401(k)s."

Those new regulations were not onerous enough to slow growth in 401(ks), just as new legal protections for customers in health-insurance exchanges likely wouldn't curb a trend toward to switching away from the current model, Antos said.

"We're not going back there," Antos said. "We're not going back to what in four years we are going to think of as old-style employer-sponsored plans."

Families USA's Pollack recalled how just before the passage of the health law, he ran into Raul Grijalva, D-Ariz., a leader of the Congressional Progress Caucus. Pollack said he asked Grijalva if he would back the law, and the congressman responded with a "diatribe" of its failings. Pollack said he then went through with Grijalva some of the failings of the original version of the Social Security Act of 1935, such as excluding many women from its protections. These shortcomings were addressed in later laws.

"Those things got fixed" in the Social Security Act, Pollack told the audience at AEI. "And, the Affordable Care Act is not the last word in how we're going to change America's health care system. It's a major change to be sure ... but it will be modified."

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