GOP Senate majority might target ACA device tax

While Republicans picked up seven seats in the U.S. Senate on Nov. 4 to assume a majority, recent good news surrounding the Affordable Care Act (ACA) will likely safeguard major aspects of it from GOP repeal.

Three of the nation’s largest insurers - Aetna, WellPoint and UnitedHealth Group –recently posted third quarter profits that exceeded Wall Street expectations, and all will be maintaining or adding to plan offerings during the next ACA open enrollment cycle, which begins Nov. 15.

That news, along with the drop in the country’s uninsured rate, could help protect major parts of the ACA from a targeted GOP appeal.

One element of the law that could be challenged is the medical device tax, which has triggered intense lobbying from the healthcare industry and has bipartisan repeal support, according to the Washington Post.

On the Medicaid expansion front, Republicans governors won in six key states where party changes were possible, leaving the future of expansion in doubt.

Kansas Gov. Sam Brownback defeated Democratic challenger Paul Davis, who favors a customized Medicaid expansion option. In Alaska, Gov. Sean Parnell fended off Democratic challenger Bill Walker. Parnell opposes Medicaid expansion but is seeking state solutions to close the gap for low-income Americans too poor to afford insurance through the state exchanges.

In Florida, where 1,392,000 residents would gain Medicaid benefits under expansion, Gov. Rick Scott defeated Republican-turned-Democrat challenger Charlie Crist. Scott has said he supports expansion, but the majority Florida legislature does not, according to Avalere Health.

Wisconsin Gov. Scott Walker withstood a challenge from Democratic Mary Burke, who strongly supports expansion. Walker’s administration rejected federal Medicaid expansion funds but restructured the state’s eligibility standards to allow more residents to gain coverage. Fully expanding Medicaid would allow 120,000 more to gain insurance. 

A total of 28 states plus the District of Columbia have chosen to expand Medicaid since the U.S Supreme Court decision in June 2012 made expansion a state option. The latest to join was Pennsylvania, whose Republican governor, Tom Corbett, announced an agreement with the U.S. Centers for Medicare and Medicaid Services (CMS) to offer a Private Coverage Option to uninsured adults between the ages of 21 to 64 who are below 133% of the Federal Poverty Level.

Wyoming and Tennessee are considering a customized expansion option like that adopted in Pennsylvania, while both Utah and Indiana have submitted alternative plans like Pennsylvania’s and are waiting on approval from CMS, according to the Kaiser Family Fund.

If Medicaid expansion had been implemented in every state instead of being a state option, more than three million people, many of them in the South, would now have Medicaid health insurance benefits, according to an analysis by the New York Times.

Republican opposition to the ACA has tapered off recently as insurers report profits and the national uninsured rate falls.