The Supreme Court's ruling to uphold health care subsidies almost certainly put an end to conservatives' chances of taking down Obamacare. While some GOP politicians-particularly those running for president-continue to tell the party's base that repeal is an achievable goal, the reality is that it remains very unlikely to happen.
So, where do we go from here? In the 2014 midterm elections, Democrats-especially those from red states- were forced to walk a fine line. They were already on record supporting the law, but thanks to a botched rollout, and effective messaging from conservatives, it wasn't popular with voters.
Last year, some of those senators joined with other Democrats in pushing a number of proposals they felt would make Obamacare better. In an op-ed published in Politico, the senators wrote:
As each of us has said from the beginning, the ACA is not perfect. And as each of us has promised, we are taking important steps to make the law work even better for families and small businesses across the country...
...We encourage our colleagues from both parties, in the House and the Senate, to join us in this responsible effort to make the Affordable Care Act work better for America's families and businesses.
In 2016, Republican senators may be facing the same kind of choice. Many of them rode into office in 2010 because their anti-Obamacare message was popular with voters. Next year, however, those senators will be facing a presidential electorate, which will trend much further left than the one that voted them into office in 2010.
The electorate isn't the only thing that will be different from 2010. Six years ago, Obamacare was a newly enacted law that had yet to take effect. None of their constituents were benefitting from the law's subsidies and coverage provisions. Now, these senators will be facing voters who have health insurance because of Obamacare. On top of that, one recent government report even found that repealing Obamacare could add as much as $353 billion to the federal deficit and cost 24 million Americans their health insurance.
This complex political balancing act, coupled with many moderate Democrats already on record supporting fixes to the law, could provide a rare opportunity for bipartisanship on such a contentious issue.
Obviously, Democrats and Republicans will disagree over how flawed the law really is, and what parts of the law need to be fixed, but the overall notion that there are areas for improvement is a starting point for potential agreement.
So, what would such a bill look like? First, the employer mandate exemption would be pushed from businesses with at least 50 employees to those with at least 100. Second, it would allow people enrolling in Obamacare to do so through agents and brokers, rather than having to navigate a website.
There is also support on Capitol Hill for striking a deal to do away with certain taxes in the law.
Other lawmakers are floating the idea of mixing repeal of part of Obamacare, such as the medical device tax, which is loathed by members of both parties, with non-health care items such as broader tax reform.
While the medical device tax gets the most media attention, another Obamacare tax that has support for repeal is the "Tan Tax." According to Forbes, the 10 percent excise tax on indoor tanning services has not yielded the revenue the law's authors had hoped:
The tanning tax was expected to raise $2.7 billion over the first decade of its existence. Five years into that decade, it has raised less than $500 million. For the decade, the industry projects it's on pace to throw off only $840 million-about a third of what was expected.
The Forbes piece also points out the negative impact the tax is having on jobs in the industry:
Nearly 10,000 tanning salons have closed since the tax went into effect. This has resulted in the loss of nearly 81,000 jobs...
In order to ensure these changes are fiscally responsible, lawmakers will have to find ways to make up for the more than $30 billion lost by repealing those tax provisions.
Last September, the Center for American Progress (CAP) outlined numerous tax reform ideas that had strong bipartisan support. Closing a loophole that allows life insurance policies for a company's employees to finance their debt with life insurance investments could raise about $7 billion over 10 years. Another, the corporate jet subsidy, which grants "a larger tax benefit for jets that transport executives than airlines are given for jets that carry passengers, could raise $3.8 billion over 10 years.
These proposals are just two ways that Democrats and Republicans could include in a fix bill that would keep the law on sound financial footing.
If Democrats and Republicans can work together to take a "mend it, don't end it" approach to Obamacare, it could be a defining moment. It would ease the minds of the millions of Americans who receive health insurance through Obamacare, and it would show that both parties can work together on serious policy initiatives on the most important issues facing the country.