- The Washington Times - Sunday, June 29, 2014

There is no Obamacare retreat in Sen. Orrin G. Hatch’s office. The Utah Republican promises that President Obama’s signature health care law will cease to exist in its current form if Republicans win control of the Senate this fall.

Mr. Hatch, who is poised to become chairman of the powerful Senate Finance Committee if Republicans regain the majority, has been chipping away at Obamacare as a ranking member. He has offered numerous amendments to the Affordable Care Act since it became law, such as delaying tax credits and subsidies to certain immigrants and banning abortion coverage.

Mr. Hatch also has co-sponsored a bipartisan bill that would repeal taxes on medical device companies as a way to fund the Affordable Care Act. He says the bill has enough Democratic support to pass on the Senate floor if Majority Leader Harry Reid, Nevada Democrat, would allow a vote. It’s one of the first pieces of legislation that would be approved under Mr. Hatch’s leadership if Republicans win the Senate.

“We have to win this election. We have to have Republicans take control of the Senate, and if we do, we have to change Obamacare,” said Mr. Hatch. “The American people are really upset right now and they’re concerned with — what I think great justification — that they’re going to be big losers. They will be if we keep Obamacare going.”

Mr. Hatch, along with Sens. Tom Coburn of Oklahoma and Richard Burr of North Carolina, have offered a blueprint for the Republican replacement of the Affordable Care Act. Their plan builds on many of the key elements of Obamacare but isn’t full of government-issued mandates. It instead focuses on the free market and individuals making decisions for themselves.

Until Republicans can control the White House and successfully repeal the health care measure, they are looking for ways to modify and mitigate the legislation’s damage before parts of it are intractable — regulations forever lodged in the bureaucratic malfeasance of Washington, they say.

A Kaiser Health Tracking Poll survey conducted in May shows public opinion remains negative toward Obamacare, with 45 percent of the public having an unfavorable view of the health care law versus 38 percent who like it. About six in 10 say they would prefer their representative in Congress to work to improve the law, while about a third want their representative to work to repeal the law and replace it with something else.

“We need the White House and from that standpoint it’s going to be very difficult to get rid of Obamacare for the next two years,” said Mr. Hatch. “But there’s going to come a time when even the president is going to have to face reality and where even he’s going to have to say, ‘Look, I’m tired of fighting this — they have some good ideas and maybe we can work together.

“Up until now, they haven’t been willing to work with us, and when you have a bill that passes with 60 Democrats — and only Democrats in the House and the Senate — you know it’s a lousy bill,” Mr. Hatch said. “Something that’s this controversial and this important and this costly.”

Under the Republican plan, regulations on what insurance companies must provide in their offerings would be erased, tax cuts for employer-sponsored insurance would be reduced for employees with “Cadillac” plans, the expansion of Medicaid would be undone, and tax credits would be provided to help lower-income people buy private insurance — paid for by the reduction in tax credits given to employer-sponsored insurance.

The most popular elements of Obamacare — allowing young adults to stay on their parents’ plans until they are 26 and not allowing insurance companies to drop individuals from their plans because of pre-existing conditions — would be kept.

Those with pre-existing conditions would be allowed to change their health care plans or sign up for coverage during an open-enrollment phase, that if missed and coverage lapsed, would not be given the same guarantees for later enrollment. This aspect would prompt more consumers to get covered during these open-enrollment periods, as well as give insurers a steadier risk profile on their enrollees, allowing for greater pricing flexibility.

“This is the most feasible Republican alternative to Obamacare so far,” said Yevgeniy Feyman, a health care analyst at the Manhattan Institute who has studied the plan. “It ensures within the structure of Obamacare as little disruption as you can possibly have.”

“Those who bought coverage on the Obamacare exchanges can keep it. But the bill pulls down the floor for requirements — there are no minimum benefits that plans must have and insurers must provide, so it injects new potential plans into the marketplace that will ultimately lower the cost and give people more choices for coverage,” Mr. Feyman said.

Mr. Hatch knows how to broker a deal in the Senate. He has sponsored or co-sponsored the most laws of any current senator — 742 — compared with the median of 78.

With a Republican-led Senate, it’s likely that some of the tenets in Obamacare could be modified and replaced with something more palatable for Republicans, said Dennis Smith, a managing director at McKenna Long & Aldridge LLP who served in the George W. Bush administration as Medicaid director and as health and human services secretary in Wisconsin.

“The Democrats just want to consolidate all of the authority in Washington, but the Republicans care just as much about our vulnerable populations. So the differences are not about whether there’s a role for government, but what level of government and where the decision-making lies,” Mr. Smith said.

Liberal groups have attacked the Hatch & Co. health care plan and have condemned its provision to scale back the rules for people with pre-existing conditions.

“Making it legal again for big insurance to discriminate against and deny coverage to 89 million Americans with pre-existing conditions is not an alternative — it’s a joke,” Americans United for Change said in a statement. “A sick one at that.”

Still, criticisms are not deterring Mr. Hatch or others in the Senate who think Obamacare is unworkable.

“Right now, you talk about affordable health care and [Democrats] don’t think there are any better ideas even though they’re changing the deadlines on a daily basis, they’re unilaterally changing the bill, instead of facing it upright and saying let’s redo this bill and get it done right,” said Mr. Hatch. He added that Republicans are willing to work with “Democrats who are open and honest to try to come up with a health care system that really does work and doesn’t cost the American taxpayers trillions of dollars extra.”

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