5 more ways a Republican Congress could change PPACA

The Republicans will hold a majority of the seats in the Senate in 2015, and a big majority in the House.

Yesterday, we looked at 5 ways Republican control over both chambers of Congress might affect actions involving the Patient Protection and Affordable Care Act (PPACA) and other health policy issues.

Today, we’ll look at how Republican control over Congress might affect the implementation — or lack of implementation — of specific PPACA provisions.

One obstacle facing Republicans is that the Republican majority will have too few seats in the Senate to force ordinary bills to the Senate floor, or to overturn presidential vetoes.

Another challenge may be intra-party disagreements about policies and strategies. In recent years, House Republicans could count on getting almost all Republicans to vote with the party leadership on all votes. In the Senate, the Republicans suffered from a few defections on key votes, but not many.

This week, there are signs that Republicans could face divisions in the Senate, with Sen. Ted Cruz, R-Texas, and other Tea Party populists challenging traditional Republicans, like current Senate Republican Leader Mitch McConnell, R-Ky., who have been open to talking to representatives from insurance companies and other big businesses, and who have been open to compromising with the Democrats on some critical votes.

But the Senate Republican majority is young, and it’s possible that, in some cases, “populism” may be a euphemism for “dissatisfaction with financial support.”

McConnell, for example, received $903,000 in contributions from individuals and political action committees in the insurance sector for the current election cycle, and insurers rank fourth on his sector contributor list, according to OpenSecrets.org. Health services organizations and health maintenance organizations (HMOs) have contributed $490,226. Cruz, in contrast, has received just $24,585 from insurance sector contributors and only $7,600 from health services companies and HMOs.

Here’s a look at what happens to five controversial PPACA provisions if the traditional Republicans prevail or the populists prevail.

1. Exchange plan performance reporting requirements.

The PPACA proposals with the best chances of becoming law may be those that are small and cheap, and won some Democratic support in the House before Nov. 4 — when Senate Democratic leaders generally declined to touch, let alone talk about, PPACA bills that came from the House.

In January, Reps. Lee Terry, R-Omaha, Neb. and Bill Cassidy, R-La., were trying to drum up support for H.R. 3362, a bill that would have required the U.S. Department of Health and Human Services (HHS) to publish weekly PPACA exchange activity reports in a specified format.

That bill attracted yes votes from 33 House Democrats, including Democrats such as Rep. Albio Sires, D-N.J., who have rarely crossed party lines when voting.

Our prediction is that Republicans may be able to make a PPACA exchange reporting measure law, even if President Obama vetoes it.

2. Medicaid expansion.

Many Republicans have opposed the idea of states taking PPACA Medicaid expansion money from the federal government, arguing that the federal government doesn’t really have the money, and that the stream of funding will be unstable.

But hospitals love what Medicaid expansion is doing for their revenue and profits. Hospitals have contributed about $9.2 million to Republican candidates during the current election cycle, and they have strong ties to the Republican Party. William Frist, a former Republican Senate majority leader, is from the family that started HCA, a big hospital company.

Health insurance groups generally seem to like having a chance to bid on Medicaid program administration contracts, and insurance producer groups cannot typically show that members are jumping over themselves to sell private plans to the poorest consumers.

Republicans seem to be unlikely to have much luck with repealing the Medicaid expansion program, until and unless major problems crop up.

Image: Jeffrey Daniel, a nurse in Utah, listens to a patient inhale. (AP photo/Rick Bowmer)

3. The medical loss ratio (MLR) formula.

The PPACA medical loss ratio (MLR) provision requires major medical carriers to spend at least 85 percent of large-group revenue and 80 percent of individual and small-group revenue on health care or quality improvement efforts.