For House Republicans, Finding Obamacare Replacement Is No Easy Task

john boehner

“While both parties agree that we must make healthcare more accessible, we in the majority fundamentally disagree that more government is the answer,” stated House of Representatives Majority Leader Eric Cantor in May of last year, as the Republican party pushed to repeal the Affordable Care Act before the implementation of its cornerstone provision — the individual insurance exchanges. His comments are noteworthy for the fact that he acknowledged the American healthcare system not only needed a fix, but needed to be made more accessible.

In the months since that statement was made on the floor of the House of Representatives, the insurance marketplaces have launched, criticism has been dumped on the Obama administration for the initially poor performance of the healthcare websites and for the cancellation of millions of so-called non-compliant insurance policies, and, with just five weeks remaining until the end of the enrollment period, 4 million people have signed up for coverage. But the Republican party has yet to find any alternatives to the healthcare reform, and 2014 is a congressional election year.

The Affordable Care Act — known colloquially as Obamacare — has dominated the Republican Party’s rhetoric for years. GOP lawmakers have come to terms that they must propose some piece of legislation to amend the Affordable Care Act, or replace it, if they are to appeal to a broader base of voters. The politics of Obamacare are changing, and the Republican party is well-aware of that reality. “It’s no longer just a piece of paper that you can repeal and it goes away,” Wisconsin Senator Ron Johnson, a tea party Republican, told the New York Times earlier this year. “There’s something there. We have to recognize that reality. We have to deal with the people that are currently covered under Obamacare.”

But among House Republicans, there is little unity on a strategy, even though just a month ago lawmakers had rallied around a proposal made by Republican Senators Richard Burr of North Carolina, Tom Coburn of Oklahoma, and Orrin Hatch of Utah. The Patient Choice, Affordability, Responsibility, and Empowerment Act is strongly reliant on market competition, with notable differences from Obamacare; it would likely cover fewer uninsured Americans, increase premiums for many older adults, shrink Medicaid, decrease subsidies for middle class Americans, scale back protections for people with preexisting conditions, and allow private insurers to escape many of the consumer-friendly requirements imposed on them by Obamacare. In addition, it would not maintain Obamacare’s individual mandate. The bill’s authors noted that believe our proposal is roughly budget neutral over a decade,” meaning it does not substantially reduce the deficit. Rather, it seeks to modestly reduce the amount of federal spending and taxation.

Before October 1 — when the online insurance marketplaces had yet to launch — Republican lawmakers spoke of their desire to wipe the healthcare reform off the legislative map by either repealing it in parts or as a whole, or by defunding it. In fact, more than 40 attempts were made to repeal or defund. The key, of course, was to accomplish repealing or defunding the law before the insurance exchanges opened for enrollment on October 1; even though other provisions of the Affordable Care Act had already been implemented, the marketplaces would not only be exceedingly difficult to shut down after they had been rolled out, but the individual insurance mandate is also the most important piece of the reform. Texas Senator Ted Cruz, also a tea party Republican, described concerns and aspirations most clearly and most dramatically.

During an interview with conservative radio host Rush Limbaugh in late August, Cruz explained what he saw as President Barack Obama’s strategy for ensuring that the Affordable Care Act would not be repealed, significantly amended, or defunded. “He wants to get as many Americans as possible addicted to the subsidies, addicted to the sugar, because he knows that in modern times, no major entitlement has ever been implemented and then unwound.” In other words, when the exchanges are “up and running” it will be too late to prevent the overhaul of the American health system. It is true that since Franklin D. Roosevelt signed the Social Security Act during the Great Depression, no bestowed benefits have been retracted.

Now, those that wish to repeal Obamacare without replacing it are a growing minority, evidence that the party’s Obamacare politics have indeed changed from criticize and repeal to criticize and reform. The criticism part of that two-fold plan has been easy. It is reform that has been difficult; numerous alternatives have been proposed, from broad legislation to more targeted measures, but Speaker of the House John Boehner has not yet committed to voting on replacement legislation this year.

Still, Cantor gather together on Friday a group of committee chairs and other Republican leaders, who have controlled the House since January 2011, to discuss healthcare legislation. “It was a beginning discussion,” House Ways and Means Committee Chair Dave Camp said in an interview with Reuters after the meeting. “The goal is to develop consensus along healthcare policy,” he added. But Camp did not say whether the Republican party would bring health care legislation to the floor this year, and that speaks to the fractured nature of congressional Republicans. The House Ways and Means Committee has oversight of healthcare legislation.

The wide range of opinions on healthcare legislation held by congressional Republicans is evident in a brief overview of the proposals under discussion

Representative Tom Price of Georgia, a physician, wants the Affordable Care Act repealed and replaced with he has called a “soup-to-nuts reform of healthcare,” but he believes such a top to bottom effort is “not a viable option at this point,” as he told Reuters.

Meanwhile, Representative Steve Scalise of Louisiana has proposed a comprehensive bill that would first repeal Obamacare and replace it with regulations placing new limits on medical malpractice suits and expand access to health savings accounts.

Republican Representative Michael Burgess of Texas, an obstetrician, firmly opposes any wholescale healthcare reform legislation. “The big-bill concept is one I don’t support,” he told Reuters. He believes the House GOP lawmakers need to craft more targeted reforms that address the most worrisome Obamacare problems: premium amounts and doctor and provider payments. Larger issues — like a repeal — should be postponed until after this year’s midterm elections, when the Republican party may hold a stronger position in Congress, he added. “Washington is pretty unpopular right now. I don’t think you have the political capital to spend in one lift,” he said in a telephone interview with the publication, referring to Scalise’s bill.

But Representative Tom Cole of Oklahoma told Reuters that, “There is an awful lot of political impetus” for taking action on healthcare reform because of how controversial Obamacare has become. He noted that when representatives visit their home districts, “constituents ask them, ‘What are you doing about it?’” Yet, Cole did admit that passing an Obamacare replacement would be “tricky” in the House, given the complexities of the American healthcare system and the dividing views in the Republican party.

In addition, more than half of the 232 House Republicans are sponsoring a bill that includes incremental reforms like malpractice reform and buying insurance across state lines — measure that have broad-based support in the Republican party. However, Democrats say those measures are insufficient to meet patients’ insurance needs.

But repeal and reform is not out of the realm of possibility. In general, market-oriented reforms have been among the most popular for GOP lawmakers. More importantly, conservative fiscal experts have long known that broad reform is necessary to improve the country’s fiscal stability and to make health coverage more affordable. Until the passage of Obamacare, the problem has been that GOP lawmakers have had little elector incentive to make changes.

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