Congress is targeting funding sources for the Affordable Care Act as it works to reach a budget agreement before the end of the year.

Republicans want the omnibus budget package to extend funding restraints that insurance companies and failing co-op insurers say are forcing them out of the ACA’s insurance exchanges.

Also at risk are two ACA taxes that have been criticized by both parties. Two-year delays of the medical-device tax and the Cadillac tax on high-end insurance plans could be included in the budget’s tax-extender package.

Lawmakers are also considering a one-year delay on the ACA’s premium tax borne largely by health insurers.

Although Democratic leaders joined Republicans in bashing the Cadillac tax, neither side has articulated a proposal for replacing the revenue it is expected to provide.

However, Larry Levitt, senior vice president for special initiatives with the Kaiser Family Foundation, said the proposed changes would have a modest long-term effect and “wouldn’t affect the core of the ACA,” which is the expansion of insurance coverage to millions of Americans.

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Jeffrey R. Ungvary President