It seems that ever since the Affordable Care Act (aka ACA or Obamacare) was passed and then passed muster in court, nearly all Republicans have wanted it repealed. The latest efforts involve shutting down the government as we enter a new fiscal year and refusing to raise the debt ceiling so the government defaults on its debts.

Both efforts seem foolish and I have discussed them recently.

I live in Pennsylvania and get emails from Senator Toomey. He discussed his desire to compromise on the government shut-down stand-off by adding 3 amendments to the Senate bill. These amendments did not make it into the Senate bill. I do not think the debate on Obamacare should be part of the government shut-down or debt ceiling debates but these are good discussion points on the law.

The first would repeal the medical device tax that is costing Pennsylvania jobs; the second would provide relief from the infringement on religious liberty in Obamacare; the third would delay the individual mandate for one year.

I probably would back the repeal of the medical device tax. It seems to me the best way to do this would be a a separate bill but now seems a bit rushed. I don’t see much benefit to this tax since I would assume the tax would just be passed along as part of the cost of health care. So there is really no benefit since the users of heath care pay the tax and there well could be a job loss associated with this. But on the other hand with more people insured and using health care there may not be a job loss. I’d like to see more discussion on this point.

Regarding the second suggestion (infringement on religious liberty), I think this is inevitable as long as we insist on standards in health insurance. I think the employer mandate is problematic. The religious objection of an employer may or may not seem reasonable to others. One person may object to contraception and another may object to this or that aspect of health care. A public option would be much simpler here but I don’t think that is what the Senator had in mind.

As to the third point (a 1 year delay), there may be a problem. I assume the insurance companies took the widened risk-pool provided by the mandate into account when setting the rates for 2014. If this is not the case and we do not have additional delays such as a 1 year delay every year, it might be worth discussing this.

The ACA is a complex law with many parts. There are things I like and things I don’t. There seem to be things we could fix now and problems that would not be apparent until parts of the law are implemented. And we certainly could use a reasonable discussion of the pros and cons of parts of this law.

Rather than have a series of political stand-offs to attempt to repeal the law, maybe Congress could work to improve the law.