10:40 AM ET, 08/04/2011
By Sarah Kliff
For a law regularly at the center of controversy, there was surprisingly little talk of the health care reform law during the debt ceiling debate. It certainly factored into some discussions — House Speaker John Boehner (R-Ohio) reportedly pushed for the individual mandate’s repeal as a trigger — but the issue never emerged as a deal breaker. That’s a big difference from the budget debate in April, where Republicans demanded a defunding vote as one of their must-have items.
Health policy analysts are still digging through the 74-page debt deal, and are starting to come to a few important conclusions about how it would effect the health care law. The general takeaway: if the trigger goes off, the law comes out a little bruised, but relatively unscathed. But no one knows what the Supercommittee will do.
Legislators have not shied away from using reform funds as an offset: they financed the last doc-fix, for example, by shaving off some funds to the health insurance tax credit. The Gang of Six would have repealed health reform’s longterm health insurance plan, the CLASS Act, to save $86 billion; Republicans have repeatedly voted to defund the health reform law’s $15 billion Preventive Health Fund. It’s changes like these, on the table heading into the next round of the deficit debate, that have the most potential for a serious impact on the Affordable Care Act’s future.
If the Supercommittee does not come up with enough savings, and the trigger cuts go into effect, the Affordable Care Act comes out in relatively decent shape. Medicaid, which will expand up to 133 percent of the Federal Poverty Line in 2014, is shielded from the trigger. So are most of the provisions to cover the cost of insurance premiums for lower -income Americans. Since the funds are provided as refundable income tax credits, they also can’t be touched. Continue reading