President Barack Obama shakes hands with members of the audience after making remarks on the Affordable Care Act in the East Room of the White House in Washington, DC on July 18, 2013. The president highlighted a provision in the healthcare bill, which is sometimes called Obamacare, that requires health insurers to devote at least 80 percent of their spending on medical care, or give rebates to consumers. He also noted a report that many self-insured New Yorkers will see their premiums drop by 50 percent. UPI/Pat Benic | License Photo
After weeks of rumblings among the ranks and angst among analysts, U.S. House Republicans may be looking to pass along a little discomfort to Democrats in the form of votes on the Affordable Care Act, aka Obamacare.
Republicans hit what may be the nadir of the session about a month ago when they failed to pass a farm bill that also included reauthorization of nutrition programs. Just a couple of weeks ago, however, Republicans handed House Speaker John Boehner a victory -- some would say a Pyrrhic victory -- by voting 216-208 on a bill that stripped out any mention of food stamp funding. (GOP leaders said they would deal with a separate food stamp bill down the road.)
After having warts and all on display for many weeks, Republicans hoped to shift their pain to the Democrats with a pair of votes delaying implementation of parts of the Affordable Care Act.
Soon after the Obama administration announced it would delay enforcement of the employer health insurance mandate, Republicans scheduled the votes on two bills, one codifying the delay announcement and one that would delay implementing the Affordable Care Act's individual mandate.
The employer mandate requires most employers with more than 50 full-time employees to either offer insurance coverage or pay a penalty to the government. The start date for that mandate has been moved back from Jan. 1, 2014, to Jan. 1, 2015, coincidentally after the midterm elections.
When it was all over, 22 Democrats joined Republicans last week in voting to delay the individual mandate. Thirty-five supported a bill codifying the employer mandate.
Delaying, not repealing, is significant, Democratic aides said, because moderate Democrats and 2014 "frontliners" who oppose parts of the healthcare law but not the law itself were forced to punch green or red, turning their backs on their leadership and the White House to vote with Republicans in favor of the delays.
"They [Republicans] are playing this very well," a chief of staff to a moderate Democrat told Roll Call before the vote.
Republicans readily acknowledge their effort to twist Democrats ahead of the action.
"Having the votes in this fashion will highlight the hypocrisy of any Democrat who votes for delaying the employer mandate but against delaying the individual mandate," a senior Republican leadership aide said in a statement. "The administration's position is intellectually and morally indefensible -- and this week, we'll see how many congressional Democrats agree."
The White House counters any effort to delay the individual mandate is simply another version of repeal. Republicans have voted to repeal the Affordable Care Act -- either in toto or in part -- more than three dozen times since they took control of the House in 2010.
The two mandates, however, aren't apples and apples, ThinkProgress.org reported. While the employer mandate affects about 10,000 American businesses and 1 percent of workers, repealing the individual mandate would cause the uninsurance rate to be 50 percent higher than it would be If ACA were fully implemented, Obamacare, an Urban Institute study indicated. That translates to another 13.7 million uninsured.
However, the Urban Institute report said, "eliminating the employer mandate has very little effect on the distribution of coverage; it remains virtually identical to the case when the full ACA is in effect."
The Congressional Budget Office estimated repealing the individual mandate would raise premiums in the individual market 15 percent to 20 percent and increase the number of uninsured Americans by 16 million.
An aide familiar with strategy within the Democratic Congressional Campaign Committee told Roll Call Chairman Steve Israel of New York typically advises those representatives caught in the middle to "always listen to your district."
While the House postured, an ACA program that advises consumers on their new health insurance options came under fire from critics who say it puts consumers at risk of fraud, The Hill reported.
Eighteen states have enacted or are considering legislation that would apply more stringent requirements to the so-called navigators, people and organizations trained to help consumers shop for health insurance on the Affordable Care Act's new online marketplaces.
Congressional Republicans also are aligned against the navigators, arguing the program could admit felons or allow the theft of consumers' personal information.
Navigators were envisioned as community-based groups that would help people unfamiliar with health coverage negotiate through the process of selecting it. They cannot enroll consumers in the marketplaces or select plans on their behalf.
Recently released final rules require the navigators to undergo training, meet regular certification standards and receive continuing education about benefits available under the Affordable Care Act. The regulations allow states to impose their own requirements on navigators as long as the rules do not interfere with federal statute.
"Navigators are tremendously important because they do not have an economic interest in directing people to a particular insurance company," Jay Angoff, a former senior adviser to Health and Human Services Secretary Kathleen Sebelius, told The Hill. "They can be completely impartial and objective, and they should be able to function as the [federal] law intended."
Republican senators voiced their disapproval of the $54 million program in a letter to Sebelius last month.
"The standards proposed by [HHS] could result in a convicted felon receiving federal dollars and gaining access to confidential taxpayer information," the senators wrote.
Diane Boyle, the National Association of Insurance and Financial Advisors' lead federal lobbyist, said it's unlikely felons would be admitted to the program.
"We're not too concerned about that," Boyle said, explaining her organization was concerned "navigators will give advice to consumers without the same level of education that an agent would."
The administration also rolled back provisions that require state insurance exchanges to verify applicants' eligibility for new tax credits to help pay for their premiums.
But the White House and its allies insist the law's anchors -- the marketplaces and tax credits to help people afford coverage -- will be ready as advertised by Oct. 1.
"Republicans and healthcare naysayers have as much credibility as the Psychic Friends Network," Nick Papas, the White House's former healthcare spokesman, told The Hill. "The administration has an incredibly talented team that is going to get the work done."