GOP plan to change health law could bring complications

Kaiser Health NewsSeptember 20, 2010 

WASHINGTON — Republicans, buoyed by recent polls that found that their party could win the House of Representatives and pick up seats in the Senate in November, are vowing to repeal or vastly revise the health overhaul law that Democrats squeezed through Congress last spring. How difficult would it be to overturn that law, though?

"There might be a little bit of 'barking dog catches car, doesn't know what to do,' because it's not like the aspects of the law that Republicans find objectionable can be excised cleanly and neatly like a tumor from the body, leaving the parts that might be more popular," said Robert Reischauer, the president of the Urban Institute, a nonpartisan Washington research center, and a former director of the Congressional Budget Office.

Yet Rep. Paul Ryan, R-Wis., is confident that the public will support a vigorous Republican attack on the sweeping health overhaul law. He acknowledged that it will be difficult to make changes since President Barack Obama has the authority to veto legislation.

"We've got to figure out how to do that with the current occupant in the White House," Ryan said.

Here's a guide to what could be in store if Republicans call the shots:

REPEAL AND REPLACE

Ryan said his party must develop an alternative to the health law and then sell that package to the public.

"I think we need to make the case for what we would replace it with," he said. "We need to give the country an alternative system that's fiscally responsible, one that gives patients ownership and choice and one that does not create brand-new entitlements."

Rep. Henry Waxman, D-Calif., the chairman of the House Energy and Commerce Committee, said the Republicans would face opposition from the public.

"I think it will be very difficult for them to try to repeal the health care bill in whole or in part, especially when the American people see what's happening," Waxman said. "Are they going to repeal the assistance to small business to cover their employees? Are they going to try to strike some of the funding that's available for subsidies for low-income people?"

If House Republicans prevail in their repeal efforts, prospects for passage in the Senate are dim. No matter who holds the majority in the Senate, the margin between the parties probably will be very small. Legislation as combative as an attempt to repeal part or all of the health care law most surely would need 60 votes to pass, requiring that the Republicans, who now control 41 seats, win some Democratic support.

If the Republicans faced an Obama veto, they'd need to gain support from two-thirds of both chambers to override it.

DEFUND THE LAW

Republicans could turn to the annual appropriations and budget process or push standalone bills to delay or stop funding for provisions of the law that they dislike, including the individual mandate, the health insurance exchanges and the Medicaid expansion. They also might work to block the creation of a nonprofit research institute to examine the effectiveness of various medical treatments.

A major problem with the defunding strategy is that since so much of the bill is interrelated, trying to dismantle it piecemeal could lead to unintended consequences.

While the individual mandate is unpopular, "you can't pull it out of the law without all sorts of other elements falling apart," Reischauer said. Scrapping the mandate, which requires most people to have coverage or pay a penalty, would anger health insurers, a core GOP constituency.

Insurers have agreed to abide by new consumer protections, such as not denying coverage based on pre-existing medical conditions, in exchange for 32 million new customers. Hospitals agreed to payment cuts on the premise that more people would have health insurance and hospitals would have less uncompensated care.

More insured people would create additional demand for services from hospitals and other health care providers and manufacturers, such as medical device makers, helping to offset new taxes and federal payment cuts.

OVERSIGHT SHOWDOWN

Republican rule in either chamber will guarantee an onslaught of confrontational oversight hearings, with Republican leaders demanding frequent Capitol Hill appearances by Obama administration officials who are implementing the law.

Republicans could use the sessions to highlight provisions that they oppose, such as the requirement that most individuals purchase health insurance.

"When you can't achieve the ultimate objective, which of course would be repeal, what you can do is inflict as much pain as possible on the people you hold responsible for it," said Ross Baker, a political science professor at Rutgers University. "... Whether or not you might be successful in repealing either all or part of (the law) may be less important than the fact that you can go in front of voters ... and say we did our best and we'll try again."

(Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy-research organization that isn't affiliated with Kaiser Permanente.)

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