Health Reform Repeal, Defund Efforts Begin; CBO Says Repeal Will Increase Deficit By $145 Billion

On Jan. 5, the first day of the 112^th Congress, Representatives introduced ten bills to repeal or defund the Patient Protection and Affordable Care Act (ACA). The House is expected to vote on one of the repeal bills next week week, H.R. 2, Repealing the Job-Killing Health Care Law Act, sponsored by Rep. Eric Cantor (Va.).

Senate Majority Leader Harry Reid (Nev.) already has noted that the health reform law will not be repealed, given the Democratic majority in the Senate.

Nonetheless, the philosophical battle regarding health reform has begun.  As noted in the title of H.R. 2, Republicans are attacking the potential job losses among small employers once the individual mandate takes effect in 2014. The Democrats are likely to use, at least in part, the argument that repeal would increase the deficit and do nothing to reduce the uninsured.

In response to the expected vote next week, the Congressional Budget Office on Jan. 6 released a preliminary analysis of H.R. 2, which describes “the effects that repealing [ACA] and the relevant provisions of the Reconciliation Act would have on federal budget deficits, the federal government’s budgetary commitment to health care, the number of people with health insurance, and health insurance premiums in the private market.”

As a result of changes in direct spending and revenues, CBO expects that enacting H.R. 2 would probably increase federal budget deficits over the 2012–2019 period by a total of roughly $145 billion, plus or minus the effects of technical and economic changes that CBO will include in the forthcoming estimate. Adding two more years (through 2021) brings the projected increase in deficits to something in the vicinity of $230 billion, plus or minus the effects of technical and economic changes.

New House Speaker Rep. John Boehner (Ohio) has repudiated the forecast of the CBO, saying that its analysts had relied on flawed assumptions they had been provided by Democrats. "CBO is entitled to their opinion," said Mr. Boehner. In general, CBO final budgetary analyses of legislation are accepted by Congress as the official predictor of budgetary effects.

The CBO projections do not include any potential savings in discretionary spending, which is governed by annual appropriation acts. By CBO’s estimates, repeal of the health care legislation would probably reduce the appropriations needed by the Internal Revenue Service by between $5 billion and $10 billion over 10 years. Similar savings would accrue to the Department of Health and Human Services.

Under H.R. 2, about 32 million fewer nonelderly people would have health insurance in 2019, leaving a total of about 54 million nonelderly people uninsured, according to the CBO. The share of legal nonelderly residents with insurance coverage in 2019 would be about 83%, compared with a projected share of 94% under current law.

Effects On Health Insurance Premiums

According to the CBO analysis, if H.R. 2 was enacted, premiums for health insurance in the individual market would be somewhat lower than under current law, mostly because the average insurance policy in this market would cover a smaller share of enrollees’ costs for health care and a slightly narrower range of benefits. Although premiums in the individual market would be lower, on average, under H.R. 2 than under current law, “Many individuals would end up paying more for health insurance—because under current law, the majority of enrollees purchasing coverage in that market would receive subsidies via the insurance exchanges, and H.R. 2 would eliminate those subsidies,” writes the CBO.

Premiums for employment-based coverage obtained through large employers would be slightly higher under H.R. 2 than under current law. In addition, according to the CBO, “Premiums for employment-based coverage obtained through small employers might be slightly higher or slightly lower (reflecting uncertainty about the impact of the enacted legislation on premiums in that market).”

Repeal Or Defund Proposals

These are the repeal or defunding bills introduced on Jan. 5.

H.R.2: Repealing the Job-Killing Health Care Law Act. Sponsor: Eric Cantor (Va.). Referred to the Committee on Energy and Commerce, and the Committees on Education and the Workforce, Ways and Means, the Judiciary, Natural Resources, Rules, House Administration, and Appropriations.

H.R.21: To amend the Internal Revenue Code of 1986 to repeal the mandate that individuals purchase health insurance. Sponsor: Scott Garrett (N.J.). Referred to the House Committee on Ways and Means.

H.R.38: To rescind funds appropriated to the Health Insurance Reform Implementation Fund under the Health Care and Education Reconciliation Act of 2010.Sponsor: John Fleming, (La.). Referred to the House Committee on Energy and Commerce.

H.R.105: To repeal the Patient Protection and Affordable Care Act and related health-care provisions and to enact in its place incentives to encourage health insurance coverage, and for other purposes. Sponsor: Dan Burton (Ind.). Referred to the Committee on Energy and Commerce, and the Committees on the Budget, Education and the Workforce, Natural Resources, House Administration, Ways and Means, the Judiciary, Rules, Appropriations, and Oversight and Government Reform.

H.R.118: To amend the Patient Protection and Affordable Care Act to permit a State to elect not to establish an American Health Benefit Exchange. Sponsor: John Fleming (La.). Referred to the House Committee on Energy and Commerce.

H.R.119: To prohibit the hiring of additional employees by the Internal Revenue Service to implement, administer, or enforce health insurance reform. Sponsor: John Fleming, (La.). Referred to the House Committee on Ways and Means.

H.R.127: To deauthorize appropriation of funds to carry out the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010.Sponsor: Tom Graves (Ga.). Referred to the Committee on Energy and Commerce, and the Committees on Ways and Means, Education and the Workforce, the Judiciary, Natural Resources, and House Administration.

H.R.141: To repeal the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010.Sponsor: Steve King (Iowa). Referred to the Committee on Energy and Commerce, and the Committees on Ways and Means, Education and the Workforce, the Judiciary, Natural Resources, House Administration, Rules, and Appropriations.

H.R.145: To repeal the Patient Protection and Affordable Care Act (Public Law 111-148) and related health-care provisions. Sponsor: Connie Mack (Fla.). Referred to the Committee on Energy and Commerce, and the Committees on Ways and Means, Education and the Workforce, the Judiciary, Natural Resources, House Administration, Rules, and Appropriations.

H.R.154: To prohibit the use of funds for implementation or enforcement of any Federal mandate to purchase health insurance. Sponsor: Ted Poe (Texas).Referred to House committee. Status: Referred to the House Committee on Energy and Commerce.

H.R.191: To amend the Patient Protection and Affordable Care Act to establish a public health insurance option. Sponsor: Lynn C. Woolsey (Cal.). Referred to the House Committee on Energy and Commerce.

For a comprehensive analysis of the Patient Protection and Affordable Care Act, including the full text of the law and additional information on health reform and other recent developments in employee benefits, just click here.