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GOP at Cross Purposes on 'Obamacare'

Chris Maddaloni/CQ Roll Call
Cantor lost conservative support for bill that would have diverted money to the Pre-Existing Conditions Insurance Plan; House GOP leaders canceled the vote.

To repeal or dismantle? That is the internal debate roiling House Republicans as they plot their strategy on the landmark 2010 health care law, as its implementation accelerates.

Recognizing that neither President Barack Obama nor the Democratic Senate will entertain legislation that fully repeals the Affordable Care Act, House GOP leaders are pushing their conference to embrace a series of messaging bills altering or dismantling pieces of the law to publicize for voters what Republicans argue are the statute’s many failed and damaging policies. Their goal is to turn the law into an issue they can use against Democrats in the 2014 midterms.

But rank-and-file Republicans, particularly freshmen and sophomore members, worry that any legislation to repeal a portion of the law could be interpreted by their constituents as strengthening it. Or worse, many Republicans fear that repealing broadly unpopular parts of the Affordable Care Act, such as the medical-device tax, might strengthen voters’ opinion of the law, decreasing the possibility that political pressure for full repeal will mount as a predicted messy implementation progresses.

“It’s a pretty big debate and I don’t think there’s any consensus with our constituencies and therefore members don’t have an absolute [position],” Rep. Jack Kingston, R-Ga., said Thursday during a brief interview. “If you’re perceived as doing anything to facilitate implementation, you’re suspect.”

This simmering debate boiled over Wednesday, when House GOP leaders canceled a floor vote on legislation that would have diverted up to $3.7 billion from one component of the law Republicans deemed a failure, the Prevention and Public Health Fund, in order to bolster another part — the Pre-Existing Conditions Insurance Plan, which is facing implementation difficulties.

The bill was spearheaded by Majority Leader Eric Cantor, R-Va., and was intended to highlight a health care law failure while also showing voters that Republicans support the concept of helping Americans obtain insurance coverage for pre-existing medical conditions. But influential conservative advocacy groups opposing the bill labeled it a key vote, and the few dozen tea-party-affiliated members who tend to follow their lead revolted. A minimal number of Democratic votes existed for the bill, if any.

Republicans say their 2012 freshmen balked at supporting the bill because they have not yet had an opportunity to vote on full repeal — no such bill has been considered in the House during the 113th Congress. The freshmen and other conservative stalwarts are eager to prove their commitment to full repeal and skeptical that tinkering with the law or partially repealing it will accomplish their ultimate goal of completely abolishing the statute.

Even some conservative pragmatists worry that removing portions of the law will diminish the prospects of repeal. But according to one conservative operative, this particular bill failed because it was bad policy, as it attempted to shore up a component of the health care law that is integral to the law and should be opposed as a matter of policy. And, given that Senate Democrats and Obama opposed the measure, conservatives saw no strategic reason to back it.

“If it’s a messaging bill, at least get the policy right,” said Dan Holler, a spokesman for the advocacy group Heritage Action for America.

House Republican leaders are vowing to bring the Helping Sick Americans Now Act back up following next week’s recess and are expressing confidence that they ultimately will secure the votes to pass it. But privately, House GOP leaders are frustrated by their members’ opposition.

Because full repeal is a nonstarter, they’ve settled on a political strategy of whacking the health care law piece by piece. This allows them to keep the issue on the legislative agenda and highlight what they contend are the law’s many failings — especially as it is implemented and affects an increasing number of Americans. They also believe this strategy forces the Democrats and Obama to defend the statute and raises it as one the Republicans can run on in next year’s midterm elections.

A House Republican leadership aide said that GOP leaders want to repeal the health care law as much as the rank and file but have adjusted their tactics to account for the reality that Sen. Harry Reid, D-Nev., runs the Senate and Obama will serve in the White House until 2017. Republican members, this individual said, have to come to terms with this dynamic, adding that no opponent of the Helping Sick Americans Now Act spoke against it during Wednesday’s closed-door conference.

“There are some who would rather just keep driving straight, no matter what the road map says,” the House GOP leadership aide said. Added a second leadership aide: “Democrats are real good at incrementalism; we are not.”

In the Senate, Republicans favor repeal any way they can achieve it — through one piece of legislation or in several bills that dismantle it one component at a time.

House Republicans expect their skeptical colleagues to accept this strategy eventually. For the GOP freshmen, incremental attempts at repeal are likely to be easier to pass once they’ve cast their first vote to abolish the health care law in its entirety. And even the influential outside groups such as Heritage Action and the Club for Growth have left the door open to supporting bills that partially repeal the law. The internal debate, however, is likely to persist.

“I personally think we ought to do all of the above,” Rep. Jeff Duncan, R-S.C., said. “We ought to do the big things, and total repeal, and we ought to do the little chipping away issues as well.”

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