While the CBO report is unlikely to lead to substantive reforms of the Affordable Care Act’s subsidy system or the tax treatment of employer-provided insurance any time before the November midterm elections, the odds may increase sharply if Republicans take back the Senate.
In that event, President Barack Obama would feel pressure to compromise. So might Republicans. Why? As they wouldn’t be able to overturn the president’s veto in any case, they might have political incentive to show they can work with the White House, rather than just fight it. Using the exchanges as a vehicle for further market-based reforms for Medicare and Medicaid might attract additional support from pragmatic conservatives.
By focusing on the law’s labor-market distortions, both parties could agree on how to fix some of Obamacare’s most pressing problems, without having to concede their core convictions.
No safety-net program has been passed by Congress without being subject to significant, sometimes far-reaching, changes. And doing so could significantly improve Obama’s signature domestic achievement, without scuttling it and starting over.