‘Obamacare’ still a work in progress

Marking the third anniversary of the health care law’s passage in Congress, Republicans and Democrats agreed on one thing Thursday — President Obama’s signature legislative achievement could use some changes.

While GOP critics say that means scaling back, for Democrats it means expanding the law, which they see as a “work in progress” that will eventually include the kinds of coverage they had to forgo the first time around.

“There isn’t a perfect bill that has ever existed — if you know of one, please let me know — in the 200-year history of our country,” House Minority Leader Nancy Pelosi, California Democrat, said Thursday.

Specifically, Mrs. Pelosi and Mr. Obama want to mandate that drug companies give Medicare better rebates on prescription drug purchases — a move the White House says would save the federal program for the elderly some $156 billion over 10 years.

“That’s something that was very important for us in the House, but we could not get it to be part of the whole bill,” Mrs. Pelosi told reporters at her weekly news conference.

While Republican lawmakers have made it clear that a full repeal of “Obamacare” remains their ultimate goal, they were able to pass a bipartisan budget amendment Thursday night that would repeal a sales tax on medical devices.

Sens. Orrin G. Hatch, Utah Republican, and Amy Klobuchar, Minnesota Democrat, led the amendment, which passed on a 79-20 vote during debate over the chamber’s budget plan for the coming fiscal year.

As part of debate over the spending blueprint, the vote does not have the force of law. It showed, however, that economic forces in Democrats’ home states hold enough sway for senators to turn against specific provisions within the Affordable Care Act.

“Today’s bipartisan vote to repeal the medical device tax is an important step in the right direction,” said Minority Leader Mitch McConnell, Kentucky Republican.

Republicans also tout the bipartisan repeal of a provision that would have required businesses to fill out a “1099” tax form every time they paid a vendor $600 or more, while the government has clawed back potential overpayments of tax subsides to people who will buy health insurances in marketplaces tied to the law. The administration itself questioned the financial viability of the law’s voluntary long-term care provision — the so-called Class Act program — and it was repealed in the year-end “fiscal cliff” deal.

Democrats have not pointed to specific flaws in the reforms this week, but members who celebrated Mr. Obama’s law Thursday acknowledged the “1099” outcry and said issues may come up as states set up their health insurance market places, or “exchanges,” ahead of their debut in 2014.

Rep. Xavier Becerra, California Democrat, said he is disappointed that many states that have “essentially folded their arms” by declining to set up their own health exchanges, where those without employer-based insurance can comparison-shop for health coverage. But he struck an optimistic tone, noting the law isn’t going away, and argued the administration should accelerate the implementation of “demonstration projects” designed to test the impact of provisions in the law.

“We’re looking forward to celebrating anniversary No. 4,” he said on a conference call, “coming up soon.”