But that doesn’t mean the health reform law has survived the past two years completely intact. Both Congress and the administration have repealed, stalled or backed off on a handful of health provisions, including one major new insurance program. Here’s a look at the programs that have been overturned, shutdown or stalled so far.
The 1099 reporting requirement. In a rare moment of bipartisan agreement, Congress voted last April to repeal a tax-reporting requirement that would have required small businesses to file forms on any purchases larger than $600 and would have generated $20 billion in revenue. The overturning of the 1099 requirement might say more about the hurdles of repeal rather than its successes. Despite widespread agreement, from the president to Republicans to industry, that the requirement needed to go, it took nearly a year of legislative haggling to figure out how to pay for the fix.
The CLASS Act. Health-reform critics have long-derided the Community Living Assistance Services and Support, or CLASS, Act as unworkable. The long-term insurance program relied on voluntary enrollment. If only a small group of unhealthy people — those who anticipated using the services — signed up, critics argued that the program would quickly destabilize. In October, the White House announced it agreed: It could not design a program that would hew to the health reform law — which requires that CLASS beneficiaries receive a minimum of $50 in benefits per day — and make the program actuarially sound. The CLASS Act has not been officially repealed, although House Republicans are at work on the issue, but Health and Human Services has halted work on implementing the program.
The Consumer Assistance Grants. The Affordable Care Act set aside about $30 million to fund consumer assistance programs in 2010. Thirty-five states have used that money to handle questions about how to obtain affordable health coverage or appeal denied insurance claims. The health reform law also authorized future funding for the consumer assistance program but left it to Congress to appropriate that money — in contrast to most other provisions in the law, which were automatically funded into the future. When the House and Senate failed to pass a budget last year, instead enacting a short-term fix that continued all existing appropriated programs, the consumer assistance program was shut out.
A new formula for determining Medicaid eligibility. Right now, states control many ground rules in determining who is eligible for Medicaid. The health reform law looked to standardize those rules: It makes Medicaid available to everyone who earns less than 133 percent of the Federal Poverty Level, excluding any income from Social Security. That last part of the equation — the exclusion of Social Security from income calculations — turned out to be a problem, as an early retiree with a decent Social Security income could qualify for the entitlement program. The Associated Press broke the news in June that 3 million early retirees, earning as much as $64,000, could enroll in a program that is meant to serve low-income Americans. Congress tossed out that formula late last year and Social Security income will now be included in Medicaid eligibility determinations.
The number of health reform provisions that government hasn’t enacted is much shorter than the list of those that have already come into effect (John McDonough recently ran through the law and found 36 pieces of the Affordable Care Act already in effect). The biggest impact of the Republican repeal effort is probably political: It has kept debates over the Affordable Care Act going nearly two years after the legislative battle ended. That has influenced how Americans think about the law: Last winter, the Kaiser Family Foundation found that 22 percent of Americans thought the reform law had been overturned. The repeal vote may have failed, but in keeping up a debate over the health reform law’s future, it’s also had much success.