Path on Health Care Reform Still Unclear

March 2, 2017


As House Republican leaders work to bring a bill to “repeal and replace” Obamacare to the House floor in the coming weeks, it remains uncertain whether there are sufficient votes to pass the House—and whether the Senate will follow a similar path.

A draft health care bill circulating in the House during February would repeal the individual and employer mandates requiring coverage, reform the funding of Medicaid, expand the use of Health Savings Accounts, loosen insurance rules, and repeal many of the taxes imposed to fund the Obama-era expansion of health benefits (among many other provisions). Various provisions have drawn opposition from Democrats, but also from different wings of the Republican party, making unclear whether the approach could draw support from a majority of either the House or the Senate. Nevertheless Speaker of the House Paul Ryan has made clear that he intends to bring a bill to the floor in the coming weeks.

At the same time, many in the business community—including NSBA—are deeply concerned about a proposal in the draft language to limit the ability of employers to deduct the cost of employee insurance coverage as a business expense. Already faced with escalating health care costs, loss of deductibility would further increase costs on employers and further reduce the number of businesses that are able to provide a health insurance benefit, thereby throwing more workers into the already-troubled individual markets.

Further compounding NSBA’s concerns, the draft language contains insufficient reforms to meaningfully reduce health care costs, the prime priority of small businesses nationally. House leaders have cautioned that the draft is simply a working document and that changes are ongoing.

On the Senate side, there is not yet consensus on an approach. In that narrowly divided body, a health bill could not afford to lose the support of more than two Republican Senators (assuming Democrats remained united against reform). Already, at least three Senate Republicans have announced their opposition to the draft circulating in the House.