House Republican leaders will meet Friday to begin crafting an alternative to Democrats’ health care law, but they face a slate of challenges from inside and outside the conference to advancing a credible plan.
Majority Leader Eric Cantor, R-Va., will meet privately with relevant committee heads, his staff said. Budget Chairman Paul D. Ryan of Wisconsin, Education and the Workforce Chairman John Kline of Minnesota, as well as Ways and Means Chairman Dave Camp and Energy and Commerce Chairman Fred Upton, both of Michigan, will attend.
Cantor has pledged a vote to not just repeal President Barack Obama’s health care law but also replace it with Republican legislation this year. And although Cantor said in a memo to members Friday that leaders are continuing “work to finalize” the bill, the process is far from its final stages. When Cantor announced the legislative push at an annual policy retreat last month, his conference was generally supportive. Yet the Republicans have much work to do to come to an agreement on a single plan to pursue.
That task will fall to Cantor and his top committee chairmen, who will gather the party’s best ideas, build support in their respective committees and craft consensus among the conference writ large, especially factions such as the Republicans Doctors Caucus and the Republican Study Committee.
GOP leaders have been clear that ahead of the 2014 elections, the conference wants to show what it is for, not simply what it is against. Similarly, they want to show that they are not in favor of simply returning to the old health care system, which is viewed unfavorably by the electorate.
But crafting an alternative that can get 218 Republican votes — as few Democrats can be expected to back such a plan — is a tall order.
“What you’re seeing is the conference sort of looking through these various ideas to sort of pull together an alternative, and that’s going to take some time,” said David Winston, a top pollster for Speaker John A. Boehner of Ohio.
Individual members of the House and Senate have introduced legislation to replace the Affordable Care Act, but GOP leaders have yet to endorse one proposal. In the House, Reps. Tom Price and Paul Broun, both from Georgia and both doctors, have separately introduced alternative bills. The Republican Study Committee, meanwhile, touts a bill helmed by Rep. Phil Roe, R-Tenn., and has pushed leadership to start with that text as a framework when crafting a leadership-sanctioned alternative.
A Republican Senate proposal was added to the mix late last month, introduced by Sens. Richard M. Burr of North Carolina, Tom Coburn of Oklahoma and Orrin G. Hatch of Utah.
“There are a lot of really good ideas that have been put on paper already,” RSC Chairman Steve Scalise of Louisiana said recently. “We don’t need to reinvent the wheel.”
The House proposal is likely to include poll-tested measures that have broad agreement in the GOP conference, including allowing the purchase of health insurance across state lines, allowing insurance portability between jobs, expanding access to health savings accounts and limiting medical malpractice lawsuits.
Republican aides note, however, that they have yet to decide whether to move forward with a single bill or several small-bore measures.
Moving a comprehensive bill could be challenging in the conference, especially since one of the main attacks against Democrats’ law was that it is too big and burdensome.
“The GOP is struggling to find the right way to do the wrong thing, to take over the American medicine and health insurance industry,” said Jane Orient, executive director of the right-leaning Association of American Physicians and Surgeons, which has endorsed Broun’s bill.
Yet a smattering of smaller measures might not serve as a credible alternative to the wide-ranging law that is already being implemented and has already insured several million people, eliminated pre-existing condition restrictions and provided a host of other benefits.
If the GOP does succeed in crafting a bill, there are still problems in selling it, GOP aides concede. A Congressional Budget Office score could give Democrats fodder and put their members on the spot.
In 2009, Republicans proposed an alternative to the ACA, and the CBO noted that it would neither save as much money nor cover nearly as many people. Republicans pushed back, but the report opened up attacks from Democrats.
Unlike years ago, however, the law's rocky rollout will make it easier to make the case for an alternative, said James Capretta, who advised House Republicans on health care alternatives during the recent retreat.
"Whatever the replace plan looks like will be measured against the reality of Obamacare, not what was written down on paper four years ago," he said.
Yet if Republicans go for a more robust proposal than they did then, they risk alienating their conservatives. Leaders have had limited success adopting the popular ideas in the Democratic health care law in bills Republicans can support.
Last May, Cantor pushed a bill that would help Americans with pre-existing conditions by reallocating money from one of the bill’s funding streams to high risk pools. It had to be pulled from floor consideration after the conference rejected it, partly amid conservative concerns that it didn’t do enough to do away with the law. Aides said at the time that they would bring the proposal back up.
It has yet to be reconsidered.