Is Obamacare on table for 'fiscal cliff' talks?

House Speaker John Boehner says it should be, but with a Democratic president and Senate, the reality could be that Republicans will only be able to chip away at the edges of Obamacare.

Will Obamacare be targeted for possible budget cuts during upcoming talks in Washington aimed at averting a fiscal crisis in January? Speaker of the House John Boehner insists that it should be. In an opinion piece he wrote for The Cincinnati Enquirer earlier this week he called the president’s signature Affordable Care Act a massive, expensive, and unworkable government program.

“That’s why I’ve been clear that the law has to stay on the table as both parties discuss ways to solve our nation’s massive debt challenge,” he said.

Democrats, unsurprisingly, see things otherwise. The Huffington Post’s Sam Stein quotes an administration official saying this is something President Obama opposes. A top Senate Democratic aid calls the idea “absolutely” a nonstarter, according to Mr. Stein.

The reality is that aspects of Mr. Obama’s health reforms likely will be discussed when negotiations over the so-called “fiscal cliff” heat up. But another reality is that Obamacare is now the law of the land, and isn’t going to be repealed or changed in any major way as a result of a final fiscal deal.

That last point is in conflict with Boehner’s expressed wishes. The part about negotiating cuts in the law was only a few lines in his recent opinion piece. Overall he said that he and the GOP leadership would continue to try and repeal the entire law. “As was the case before the election, Obamacare has to go,” he wrote.

Well, good luck with that. With a Democratic president and Senate still in place, the best House Republicans can hope for is to chip away the law’s rough edges. As respected Washington health-care policy consultant Bob Laszewski wrote on his blog following the election, the Affordable Care Act’s fate is now settled.

“It will be implemented,” wrote Mr. Laszewski. “It will also have to be changed but not until after it is implemented and the required changes become obvious and unavoidable. We can all debate what those things will be ... but it doesn’t matter what we think will happen – time will tell.”

As to what aspects of the law might be tweaked in exchange for GOP acceptance of increased tax revenues from the rich, the most obvious are the subsidies intended to help lower income Americans purchase health insurance when the law takes full effect at the beginning of 2014.

As the law now stands, those with incomes up to 400 percent of the poverty level could qualify for at least some aid. But as senior editorial writer Conn Carroll points out Friday in the Washington Examiner, the original version of the Affordable Care Act passed by the Senate Finance Committee was less generous.

“Republicans think they can get Obama to go back to those levels of Obamacare spending,” writes Carroll.

Other obvious targets include various boards and oversight panels that the law would authorize. Among these, the Affordable Care Act sets aside $10 billion for a Center for Medicare and Medicaid Innovation. The CMMI is supposed to test methods of saving money in big government health-care entitlement programs.

The GOP thinks this is a waste and wants to reduce the group’s funding, writes congressional reporter Sahil Kapur of Talking Points Memo.

“Top Republicans have floated the idea before in previous debt reduction talks and, with the fiscal cliff negotiations coming up, will hope to reduce the funding for CMMI,” writes Kapur.