“Why shoot for the moon?” said Randel Johnson, senior vice president of the U.S. Chamber of Commerce, a vocal critic of the law and Washington’s biggest spender on lobbying. “There may be five or six things we can get done — those are the ones we’re going to focus on.”
Several elements of the law the Chamber still wants to change are significant, such as repealing the employer mandate and cutting new taxes it imposed. But the group’s current stance marks a break with the Chamber’s all-out opposition to the law when it was being debated in Congress and reviewed by the Supreme Court.
For the Chamber and other employer groups, a top priority is revising the law’s definition of full-time workers, from those who work 30 hours per week to 40 hours. Under the law, large employers are required to provide health insurance to full-time workers.
For hospitals, the focus is delaying cuts to payments they receive from the government for caring for low-income and uninsured patients, given that fewer of them may start getting insurance coverage as the result of the law than previously projected.
And an array of business interests wants to repeal the 2.3 percent excise tax on medical devices that was enacted to help pay for the health-care initiative, arguing that the tax will cost jobs and stifle innovation. A House measure that would do that has 260 co-sponsors but has not yet been taken up by the Ways and Means Committee. A similar proposal has been backed by the Senate in a nonbinding resolution.
Still drafting regulations
Big pieces of legislation typically require what one top lobbyist called “refinements or improvements or corrections,” and, with the health-care program, a main target of lobbying is the Centers for Medicare and Medicaid Services, which is still drafting regulations to carry out the law. While few involved expect quick progress, they are all keenly aware of the approach of Oct. 1, when people are supposed to be able to start signing up for health plans through online marketplaces.
“Most of the health-care industry is trying to figure out from a commercial standpoint how to work with the law, because they have to,” said Dan Mendelson, a former Clinton administration health official who is chief executive of Avalere Health, which advises companies on how they could be affected by proposed regulations.
The health-care industry has long been among Washington’s top-spending sectors when it comes to lobbying, and three years after passage of the law, that remains the case. In the first six months of this year, the industry spent $243 million on lobbying, according to disclosure records compiled by the Center for Responsive Politics.