Boswell, Loebsack join Republicans to repeal part of health care reform

All three Iowa Democrats in the U.S. House voted for the 2010 health insurance reform bill, but last week Dave Loebsack (IA-02) and Leonard Boswell (IA-03) joined Republicans in repealing a tax established under the Affordable Care Act. It's the second time this year that Boswell and Loebsack voted to roll back part of that law.

The U.S. Supreme Court will rule on the health care reform law later this month, and I'm betting the Roberts Five will strike the whole thing down. But if the high court leaves most of the law intact, a new 2.3 percent tax on medical device manufacturers will be one of many provisions scheduled to go into effect on January 1, 2014. The tax was designed to "help offset the cost of subsidizing insurance coverage for more than 30 million people."

The Congressional Joint Committee on Taxation estimates that the tax, equal to 2.3 percent of the sale price of medical devices, will raise $29 billion in the next 10 years. The tax would apply to manufacturers and importers of devices like pacemakers and stents, defibrillators, artificial hips and knees, surgical tools and X-ray machines.

House Republicans would pay for repealing the tax by recouping some subsidies provided to low- and middle-income people to help them buy insurance. Eligibility for subsidies is based on a person's income. People who experience an increase in income may receive larger subsidies than they are entitled to. The bill would allow the government to recover those overpayments.

H.R. 436, the Protect Medical Innovation Act of 2012, might have received broad bipartisan support if not for the "pay for" element, Pete Kasperowicz reported for The Hill.

Rep. Jared Polis (D-Colo.) argued that while he and other Democrats support the repeal of the excise tax, there will be Democratic opposition to the bill because it combines two other healthcare-related bills, and pays for these changes in a way they oppose. Polis called the legislation an "incoherent mess of a bill."

Aside from repealing the device tax, the bill would also allow over-the-counter drugs to be expensed under health savings accounts, and give people to access unused medical savings account balances. About a dozen Democrats were co-sponsors of the bill when it just included the medical device tax repeal, and despite Polis's comments, some are likely to join Republicans in final passage later in the day.

On June 7 the House approved this bill by 270 votes to 146 (roll call). Every Republican present voted for the bill, including Iowa's Tom Latham (IA-04) and Steve King (IA-05). Loebsack and Boswell were among 37 Democrats who also supported the legislation. The other 146 House Democrats present voted no, including Bruce Braley (IA-01).

I have not seen any public comment on this vote from members of the Iowa delegation.

The White House indicated last week that President Barack Obama would veto this bill if it reaches his desk.

The Obama administration argues the bill would amount to a tax increase on working families.

"This tax break... would be funded by increased repayments of the Affordable Care Act's advance premium tax credits, which would raise taxes on middle-class and low-income families," the administration said in the veto threat Wednesday.

But Republicans rejected the argument that recapturing subsidy overpayments is the same as raising taxes, and argued that Democrats themselves have proposed recapturing more of these overpayments as a way to raise money.

"Let me be clear - this is a bipartisan offset," House Ways & Means Committee Chairman Dave Camp (R-Mich.) said. "Increasing the amount of overpayments to be repaid was a proposal first put forward by Congressional Democrats in the 2010 Medicare doc fix legislation which passed the Democrat-controlled House 409 to 2.

"Such an offset was used again when the House passed and the President signed 1099 repeal last year, and more than 70 Democrats supported that bill," he added. "In fact, Health and Human Services Secretary Sebelius said paying back subsidy overpayments makes it 'fairer' for all taxpayers."

Observers of Congress don't expect the Senate to approve the latest health care reform rollback. The Senate has not acted on a bill the House approved in February, which repealed a different program created by the Affordable Care Act. Loebsack and Boswell were among 28 House Democrats to vote with Republicans for that legislation.

  • Votes

    I'm glad to see Dave think before he votes from time to time.  I didn't think redistricting would flip him on an issue like this though.  

    • inconsistent

      I don't understand their thinking on this unless the recent polling on hcr has them so scared that anything related is radioactive.

      It is true that the medical device tax is one component of paying for subsidies, but the tax is really an overutilization tax to reduce diagnostic test rates.

      Most of hcr is built on the idea that health care consumption rates are too high. As Vilsack said on Iowa Press:

      ... become an ACO and to work on how they keep people out of the hospital.  They are trying to figure out -- they are going to get paid based on making people well and keeping people out and concentrating on a person's needs and coming up with a team of people.

      So I'm not sure how Loebsack is thinking before he votes here. If you are a supporter of this legislation, it shouldn't be difficult to construct an argument that this is about the best bang-for-the-buck "tax" around, as it helps pay for the subsidies and reduces unnecessary testing, thus managing health care costs/federal budget.

      I would also note that the medical device makers were at the table during hcr and agreed that the expanded customer base would offset this increase. Now they have Elizabeth Warren "fighting" for them. It's a joke.


      • Very true

        His thinking is that everything radioactive or he didn't even read the bullet points associated with the legislation.  He's a smart guy and I know he's more than capable of getting a good grasp on how the programs are funded.  

        It's just like that extra 1099 vote, if people were really careful putting this legislation together, no one would have been caught off guard.  People blame Max Baucus a lot, but the bill would have required more personal responsibility on all of us if Baucus had written the bill.  

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