New York Times: Short of Repeal, G.O.P. Will Chip at Health Law

Posted on September 21, 2010

WASHINGTON — Republicans are serious. Hopeful of picking up substantial numbers of seats in the Congressional elections, they are developing plans to try to repeal or roll back President Obama's new health care law.

This goal, though not fleshed out in a detailed legislative proposal, is much more than a campaign slogan. That conclusion emerged from interviews with a wide range of Republican lawmakers, who said they were determined to chip away at the law if they could not dismantle it.

House Republicans are expected to include some specifics in an election agenda they intend to issue Thursday. Although they face tremendous political and practical hurdles to undoing a law whose provisions are rapidly going into effect, they are already laying the groundwork for trying.

For starters, Republicans say they will try to withhold money that federal officials need to administer and enforce the law. They know that even if they managed to pass a wholesale repeal, Mr. Obama would veto it.

“They’ll get not one dime from us,” the House Republican leader, John A. Boehner of Ohio, told The Cincinnati Enquirer recently. “Not a dime. There is no fixing this.”

Republicans also intend to go after specific provisions. Senator Orrin G. Hatch of Utah, a senior Republican on the Finance Committee, has introduced a bill that would eliminate a linchpin of the new law: a requirement for many employers to offer insurance to employees or pay a tax penalty. Many Republicans also want to repeal the law’s requirement for most Americans to obtain health insurance.

Alternatively, Republicans say, they will try to prevent aggressive enforcement of the requirements by limiting money available to the Internal Revenue Service, which would collect the tax penalties.

Republicans say they will also try to scale back the expansion of Medicaid if states continue to object to the costs of adding millions of people to the rolls of the program for low-income people.

In addition, Republican lawmakers may try to undo some cuts in Medicare, the program for older Americans. Many want to restore money to Medicare’s managed-care program and clip the wings of a new agency empowered to recommend cuts in Medicare. Recommendations from the agency, the Independent Payment Advisory Board, could go into effect automatically unless blocked by subsequent legislative action.

Representative Michael C. Burgess, Republican of Texas and a physician, acknowledged that repealing the law became more difficult with each passing week, as various provisions took effect and were woven into “the fabric of American life.”

Michael A. Needham, chief executive of Heritage Action for America, who is leading a campaign for repeal, said, “There will be technical challenges in unwinding the legislation.”

Many Republican candidates for Congress have emphasized their desire to repeal the health care law. Their vow is an election issue, and more — a commitment they mean to pursue, regardless of the election results.

Efforts at repeal face several hurdles:

¶ Not even the most optimistic Republicans expect to gain the two-thirds majorities that would be needed to overcome a veto.

¶ The law responds to a genuine need. The Census Bureau reported last week that 50.7 million people were uninsured in 2009, an increase of 4.3 million or nearly 10 percent over the previous year.

¶ The health care law saves money, by the reckoning of the Congressional Budget Office, so Republicans would need to find ways to achieve equivalent savings if they repealed the law. (The budget office affirmed last month that the law would “produce $143 billion in net budgetary savings” over 10 years.)

¶ While trying to repeal the health care law, Republicans do not agree on what to replace it with.

¶ Popular and unpopular provisions of the law are intertwined and difficult to separate. People like the idea of being able to buy insurance regardless of any pre-existing condition. They dislike the idea of being compelled to do so. But without such a requirement, people could wait until they got sick and then buy coverage — a situation that has proved unworkable in states that have tried it.

Administration officials, frustrated at not getting more of a political benefit from the law, plan to highlight consumer protections that take effect this week, six months after Mr. Obama signed it.

In general, insurers will be required to offer coverage to children with pre-existing conditions; will have to allow many young adults to stay on their parents’ policies up to age 26; cannot impose lifetime limits on coverage of “essential health benefits”; and cannot charge co-payments for recommended preventive services.

Kathleen Sebelius, the secretary of health and human services, said that repeal would mean “taking those benefits away.”

Moreover, she said, if Congress repeals the law, small businesses will lose tax credits that help pay for health benefits, and officials will lose tools needed to root out fraud in Medicare and Medicaid.

House Republicans said their agenda for the next Congress would focus on jobs, spending, national security and adjustments in House rules and procedures, as well as health care.

Senator Lamar Alexander of Tennessee, the No. 3 Republican in the Senate, said: “If there was a straight bill to repeal the health care law, I would vote for it because I think it’s such a historic mistake. If that doesn’t succeed, I think we’ll go step by step. We can try to delay funding of some provisions and remove some of the taxes.”

However, Mr. Alexander added: “The bill included several items that Republicans are for, such as dealing with pre-existing conditions. So we would be careful to include those in any final legislation.”

Senator Olympia J. Snowe, Republican of Maine, said she supported efforts to make major changes in the law because she doubted that it would work. The law, she said, could inadvertently create an incentive for employers to discontinue coverage because the financial penalties for not offering insurance are far less than the cost of providing it.

Mr. Hatch is working on alternatives that would give states more discretion about how to expand coverage. “I would prefer to have 50 state laboratories doing it rather than the almighty federal government,” he said.

Without changing a word of the law, Republicans, especially if they gain control of the House or Senate, can put Democrats on the defensive with Congressional hearings and investigations intended to expose problems.

Republicans said they would also try to override or rewrite some of the regulations issued by the Obama administration without a full opportunity for public comment. They could do so by attaching provisions to spending bills for the relevant regulatory agencies, among other methods.

“Wholesale repeal is highly unlikely,” said Gail R. Wilensky, who ran Medicare and Medicaid from 1990 to 1992. “But if there is a significant shift in the makeup of Congress, which appears likely, Republicans could definitely impact the regulations.”

Senator Michael B. Enzi, Republican of Wyoming, said he was particularly concerned about rules that could make it difficult for employers to keep their current health plans intact. Many Republicans also want to repeal provisions that restrict the use of health savings accounts and flexible spending arrangements for medical expenses.

How far Republicans go will depend on how many votes they have. “The more Republicans we have here, the more changes we can make,” Mr. Alexander said.