WASHINGTON — The congressional battle over health care entered a new, more sharply partisan phase this week, as Republicans began building a case for dismantling the law while Democrats and President Barack Obama fought back hard.
And though Obama said Friday he'd consider a "tweak" or two, he also sent strong signals he won't accept major changes.
GOP lawmakers pressed their points at the first hearings of the new 112th Congress, and Friday, Obama answered with a rousing defense of the 10-month-old law.
"You may have heard once or twice that this is a job-crushing, granny-threatening, budget-busting monstrosity," he told Families USA, a consumer-oriented health care group that gave him an enthusiastic reception.
"That's about how it's been portrayed by opponents. And that just doesn't match up to the reality," he said.
Obama's blunt rhetoric came three days after his calmer tone in his State of the Union address; in that speech, he said of health care, "So instead of re-fighting the battles of the last two years, let's fix what needs fixing and move forward."
But the partisan war has been escalating on Capitol Hill, and shortly after Obama spoke Friday, Republican leader Mitch McConnell of Kentucky fired back.
"We need to repeal this bill and replace it with common sense reforms that will actually lower costs, prevent unsustainable entitlement promises and make it easier for employers to start hiring again," he said.
The exchange indicates that the health care battle is likely to rage for some time, and while the odds of a GOP legislative success remain slim, Democrats remain concerned the GOP can lure enough votes to change or end less popular parts of the act.
Last week, the House of Representatives passed, on a largely party-line vote, a repeal of the entire law. The Senate is expected to vote soon. Since Democrats control 53 of the Senate's 100 seats, and it would take two-thirds majorities of each House to override an Obama veto, the effort is going nowhere.
That's one reason Republicans, who control the House, are looking at pieces of the law. Committees began hearings this week, and at the House Budget Committee, Chairman Paul Ryan, R-Wis., put the choices in stark terms.
"We face a choice of two futures," Ryan said. "And nowhere in this country is this choice more clearly defined as it is in health care. Down one path lies a dramatic decline of a government-run system on the verge of bankruptcy. There is an alternative path."
With the Democrats' strength in numbers, even getting piecemeal changes adopted will be tough.
Republicans' biggest target is the individual mandate, which requires most people to have coverage by 2014 or face penalties. Chances are, that issue will be decided by the courts, since more than half the states are challenging its constitutionality.
In the meantime, conservatives are eager to deny funds the new law needs to work. The nonpartisan Congressional Budget Office figures that government agencies will need $10 billion to $20 billion over the next 10 years.
The Internal Revenue Service will need personnel and technology to help put into place the new system of tax credits aimed at helping lower-income people afford coverage. The Department of Health and Human Services needs funds to help officials write regulations governing insurance exchanges, or marketplaces where consumers can shop for coverage.
GOP lawmakers also are eyeing $106 billion in grants and other programs through 2019, including aid to the Indian Health Service. But any such defunding would need to survive a presidential veto, making it next to impossible.
Republicans also are eager to permit insurers to sell policies across state lines, a change they say will make rates more competitive. Currently, people can only buy individual health policies sold by firms licensed in their state.
They also want changes in medical malpractice; Obama said Friday he's "open" to ideas.
The gist of his message Friday, though, was to refute the broader Republican arguments.
House Speaker John Boehner, R-Ohio, has repeatedly referred to the law as "job crushing." At a House Ways and Means Committee hearing this week, Chairman Dave Camp, R-Mich., lamented that the law "compounds the uncertainty employers and entrepreneurs are facing under the most challenging economic climate since the Great Depression."
Nonsense, Obama said.
The economy has been growing since he signed the bill 10 months ago. And though Republicans contend that the law will mean more government spending, the nonpartisan Congressional Budget Office has estimated that repealing it would add $230 billion in deficits over the next 10 years.
"Health reform is part of deficit reform," Obama said.
And what about parts of the law already in effect? Insurers can't deny coverage to children with pre-existing conditions, certain Medicare prescription drug beneficiaries got a $250 rebate check to help them with their bills, and adult children up to age 26 could stay on their parents' health plans.
"I don't want to tell students that we're booting them off their parents' coverage. I don't want to tell seniors that their medicine is out of reach again," Obama said.
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