(Bloomberg) — Health insurers won a victory in 2015 when atax that was part of the Affordable Care Act was suspended. Now asthey fight to repeal or delay the tax again before it comesback into effect, the odds don’t seem to be in their favor.

Insurers, businesses and conservative groups are scrambling forways to at least delay the health insurance tax, or HIT, followingthe collapse of health-care legislation in July. They seemed poisedfor victory just a few months ago, when the health-insurance fee,and most of the other levies enacted to help fund Obamacare, weretargeted in repeal bills passed by House Republicans and consideredby Senate Republicans.

The health-insurance tax, which is scheduled to go backinto effect in December, is an annual fee owed by insurers suchas Anthem Inc., UnitedHealth Group Inc. and Aetna Inc. thatvaries based on their share of net premiums written nationally --the aggregate amount owed would total $14.3 billion in2018. Those opposed to the tax are trying to pitch the messagethat repealing it could prevent higher premium costs forconsumers.

The HIT took effect in 2014, but an omnibus bill passed at theend of 2015 temporarily suspended it starting last year.

Health care premiums

With a full Obamacare repeal stalled, one option for HITopponents is to push for including its repeal or delay in broaderlegislation to overhaul the U.S. tax code, according to threepeople familiar with the effort. An alternative would be to add theprovision to a continuing resolution to fund the government, saidthe people, who asked not to be named because they weren’tauthorized to speak publicly. Both options face considerableopposition.

“There’s broad agreement in Washington that we need urgent,bipartisan solutions to improve health-care affordability,” saidElena Tompkins, executive director of Stop the HIT, a coalition ofindustry groups and small business associations that wants torepeal the tax. “It’s why we need Congress to act now and provideimmediate relief from the health-insurance tax.”

Tompkins said Congress needs to take action as soon as possiblesince insurance companies lock in premiums for the individualinsurance exchanges in September. She said the group is consideringall legislative options.

Three dozen conservative groups and activists includingAmericans for Tax Reform urged House Speaker Paul Ryan and SenateMajority Leader Mitch McConnell to repeal or delay the HIT andObamacare’s medical-device tax, to avoid “higher premiums andhigher costs for middle class families, seniors, and smallbusinesses,” the groups said in a letter dated Aug. 10. Thehealth-insurance tax will increase premiums by $5,000 per familyover the next decade, the letter said, citing research from theAmerican Action Forum.

Revenue loss

Ryan has signaled openness to eliminating another Obamacare levy-- a 3.8 percent net investment income tax on top earners -- aspart of a tax overhaul but he’s been firm so far on thehealth-insurance tax. The difference is that the investment taxaffects “capital income” and might slow the economic growth that heand other Republicans have pledged to deliver, Ryan said. “Othertaxes that affect health care, like the HIT tax and those taxes,those we see as part of Obamacare,” he said.

Ryan’s reluctance may be related to making Congress’s tax-mathwork. The health-insurance tax is estimated to raise $145 billionover a decade, according to the Congressional Budget Office. Thatrevenue loss would further complicate efforts to keep any taxchanges from adding to the long-term federal deficit. Republicanleaders need to achieve that goal in order to use a budgetprocedure that allows them to bypass Democratic opposition in theSenate.

“If you’re going to cut the corporate tax rate, somebody’s gotto pay for it,” said Don Williamson, the executive director of theKogod Tax Policy Center at American University.

A spokeswoman for Ryan didn’t respond to requests for comment.Lauren Aronson, a spokeswoman for the tax-writing House Ways andMeans Committee said in an email that Chairman Kevin Brady still“believes the best way to get the Obamacare taxes out of theeconomy is through health-care reform legislation.”

‘Fiscal mania’

The industry may also lobby for adding a repeal or delay of theHIT into a continuing resolution, which would fund the governmentafter September if a formal budget hasn’t been approved, as appearslikely. A continuing resolution would need Democratic support,since it requires 60 votes to pass in the Senate.

Since the tax provision is estimated to lose revenue, it wouldhave to be offset with cuts to mandatory programs like SocialSecurity or Medicaid under budget rules, according to BillHoagland, senior vice president at the Bipartisan Policy Center.That’s unlikely to get any endorsement from Democrats, Hoaglandsaid.

Lawmakers could also look to the reauthorization of theChildren’s Health Insurance Program funding bill as a possiblevehicle for repealing parts of Obamacare, Senator John Cornyn, theNo. 2 Republican, told Bloomberg BNA.

Congress needs to resolve other pressing issues before year’send, including raising the debt-limit. “It is going to be justfiscal mania all fall,” said Maya MacGuineas, president of theCommittee for a Responsible Federal Budget, which advocates fordecreasing the deficit.

As for repealing or delaying the HIT, she said: “I can certainlysee this not happening.”

Even a standalone HIT repeal bill that has 155 cosponsors in theHouse could run into problems with timing given the packedlegislative calendar, she said.

‘Top issue’

The industry trade group America’s Health Insurance Plansestimates that reinstating the tax would increase premiums by asmuch as 3 percent. It also said that the HIT costs employees ofsmall business $210 annually and $530 for families.

Insurance companies including Anthem, UnitedHealth and Aetnalobbied on the tax in the second quarter, according to disclosures.Aetna spent almost $1.4 million on lobbying on all issues duringthe quarter, filings show.

The Chamber of Commerce, which is often the highest-spendinglobbying group in Washington, also urged Congress on Aug. 3 todelay the tax again as part of an effort to stabilize insurancemarkets.

Though the effort faces difficulties, if the industry were ableto get the HIT moratorium reinstated, companies including Anthem,UnitedHealth and Cigna Corp. could see analysts’ estimates of theirincome growth jump, said Ana Gupte, a senior analyst atLeerink Partners, who covers health-insurance companies. Additionalpercentage growth in the “mid-single to as much as teens” rangemight be plausible, she said.

Gupte said insurers are assuming the tax will return, butthey’ll still try to do everything they can to fight it.

“It is their top issue, and regardless of their mix of businessthey have something at stake here,” she said.

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