Almost from the start, theCadillac tax has been running on fumes. Both parties have signaleda desire to see it go away. (Photo: Shutterstock)

In an ironic post-election development, a key piece of theoriginal funding mechanism of the Patient Protection and AffordableCare Act could finally be dispensed with because of the House ofRepresentatives power shift.

The excise tax on employer health plans–known colloquially asthe Cadillac Tax–was designed to fund the subsidiesthat created the “health care-for-all” system of the ACA. Butalmost from the start, the Cadillac tax has been running on fumes.Both parties have signaled a desire to see it go away. Now, thatmay finally happen.

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“Eliminating the excise tax has a history ofbipartisan support. It's been delayed twice already. Thereis a high likelihood Congress can postpone it again or repeal it,”said Steve Wojcik, vice president for public policy, NationalBusiness Group on Health.

Democrats have actually led the effort to kill the Cadillac, hesaid. Meantime, it's main proponent was outgoing House Speaker PaulRyan, R-Wisconsin. With Ryan's retirement and a Democratic majorityin the House, the tax seems doomed, Wojcik said.

“It's urgent for them to act in the next year, before it takeseffect in 2020,” he said. “But all signs point to at least anotherdelay if not repeal.”

Wojcik said the election's outcome means Obamacare almostcertainly will not be dismantled; the GOP simply doesn't have thevotes. He anticipates some or all of the following will be approvedby the House now that the Democrats have control:

• Expansion of the PPACA
• Improvements to the public exchanges
• Further Medicaid expansion
• Possible Medicare expansion
• Measures designed to block efforts to weaken the publicexchanges
• Further controls on prescription drug prices
• Paid employee leave legislation

“Whatever legislation passes the House may not gain Senateapproval, and if it does, it will likely be modified beforeanything goes to the President's desk,” he added. “The next HouseSpeaker will likely need to balance an incremental, practicalapproach to health care with the more wholesale changes theDemocratic left is advocating.”

Wojcik said he did not foresee any move to limit access toinsurance for those with pre-existing medical conditions. “That wasbasically an election year issue raised by Democrats to focusattention on healthcare,” he said. “No one seriously wanted to doaway with that protection.”

“Two years of maneuvering but little progress on health care” atthe national level: That's the prediction of Kaiser FamilyFoundation President and CEO Drew Altman. In an article publishedon Axios two days after the election, Altman said the Democraticmajority in the House all but guarantees a stalemate on mostPPACA-related issues for the next two years.

“No new health legislation of any significance will pass in thisCongress,” he said. “Democrats in the House will try to cometogether on a health agenda for the party while their presidentialcandidates pursue their own platforms. Democratic oversight of theadministration's actions in the House will be unremitting and inthe news. And most of the real action affecting people will be inthe states.”

Those favoring Medicaid expansion should see it in happen.

“Overall, the results will give Medicaid expansion more momentumand red states a larger stake in Medicaid. That will make it eventougher for a future Congress to enact Medicaid cuts,” he said.

Altman's advice: Forget Washington, the action will be at thestate level. How that will play out remains to be seen.

“Just how much even the most aggressive oversight can slow theadministration and red states down remains to be seen. Meanwhile,blue states will continue to go their own way, trying to strengthenregulations to control costs and protect consumers and improvetheir Medicaid programs,” he said.

Read more: 

• Midterms could open door for more states totax opioid manufacturers
• How will the midterm results affect the benefitsindustry?
• Why the future of the ACA could be decided at themidterm elections