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Parts of health care reform law should be on 'fiscal cliff' table

December 10, 2012 - Mike Maneval
The "fiscal cliff" discussions - an effort to avoid automatic spending cuts and increases to earned income, payroll and other taxes in the new year - inch along languidly, as they have for weeks.

An idea that surfaced earlier in the debate, and seemingly been set aside as the national discussion has become more fixated on the question of whether rates for the top income brackets should revert to Clinton Adminstration-era levels or if limiting deductions and other targeted tax relief would sufficiently match spending cuts with revenue, is using the "fiscal cliff" as an opportunity to revisit the health care reform law. House Majority Leader Eric Cantor, who represents the southeastern coast of Virginia, suggested a month ago as the spotlight began turning in earnest to the donnybrook that it would be "unrealistic" for the law to remain "off the table."

If the Republicans in Congress who suggested the initiative meant for another vote to repeal the law in its entirety, as they've done more than 30 times already only to fall short of a majority each time, then the failure to gain traction is deserved. But if the Republicans want to put some of the most counterproductive and burdensome portions of the law on the table, an effort to abolish the medical devices tax should both be lauded by voters and a compromise amenable to the Obama administration.

The "fiscal cliff" talks already aim to resolved matters of increasing revenue from some tax streams, and of cutting spending on assistance programs and other expenses. Money to cover what would be lost by elimination of the new tax on equipment necessitated by the fortunes of health could be identified. And the highly targeted new tax - targeted not as a penalty for some market-distorting behavior but toward some of the most vulnerable Americans - is quite possibly the most loathesome aspect of a law that, for all its strengths, has many weaknesses too.

Another specific portion of the health care reform law that could be a candidate for reversal or revision is the consumer mandate. The mandate has been defended as necessary to guarantee consumers don't delay the purchase or health insurance until they are in the midst or on the verge of racking up expenses for treatment. While I've expressed doubts that such behavior truly is a significant problem, a more finely-tailored mandate could exclude penalty for failing to buy health insurance to consumers engaged in specific practice that allow them to game the system, to receive benefits for which they've only paid intermittantly and partially.

The "fiscal cliff" affords Republicans, two years after their counterproductive efforts to shut down all serious efforts to reform health care, another chance to eliminate the law's most counterproductive measures. If the desire of the party's leadership in Congress is to annul its worst encroachments, they may - and deserve to - succeed. If they want to consider, again, reversing the whole law, its bad and good parts, then they likely have already - and deserved to - fail.


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