WASHINGTON — Small businesses would have an easier time banding together to offer insurance to employees. Consumers could cross state lines to buy coverage. There'd be no big government expansion.
Those are among the ideas that Republicans in the House of Representatives plan to push later this week, as lawmakers expect to begin debating how to overhaul the nation's health care system.
One longtime favorite Republican proposal apparently will be absent: The Republican plan will contain no tax incentives for consumers who buy insurance individually, said House Minority Leader John Boehner, R-Ohio.
"Cost," he said, was the reason for the omission.
Chances are that little or none of the Republican plan will become law, since the House has 177 Republicans and 256 Democrats and Democrats control 60 of the Senate's 100 seats.
The Republican strategy has two missions: Illustrate what the party stands for, and try to demonize and defeat Democratic initiatives.
Some analysts questioned whether the effort would work.
"It's hard to see how Americans worried about the cost of insurance or who goes without coverage would see this as a viable alternative to the Democratic plan. I guess its appeal is to the middle class, who may see it as a way of bargaining down costs," said Steven Smith, the director of the Weidenbaum Center on the Economy, Government and Public Policy at Washington University in St. Louis.
House Democrats have proposed a 1,990-page bill that includes a government-run insurance plan, or "public option," that would compete with private insurers. Savings in Medicare and a tax on the wealthy largely would pay for the legislation, which has been estimated to cost a net $894 billion over 10 years. The tax surcharge would apply to adjusted gross incomes of more than $500,000 for individuals and $1 million for joint filers.
Debate on that plan could begin late this week, with final votes late this week or early next week. The Republican plan would be offered as an alternative.
House Republicans plan a series of efforts, including a 12-hour online town hall meeting beginning Thursday afternoon, to call attention to what they see as problems with the Democrats' plan.
Their message: "This would be a government takeover of health care in this country," House Republican Conference Chairman Mike Pence of Indiana said.
In the Senate, Majority Leader Harry Reid, D-Nev., has proposed a public option that would permit states to "opt out" of the plan. He's encountered serious resistance from party centrists, and no Senate debate is expected this week.
Many of the Republican ideas are expected to surface in the Senate, where the rules make it easier to amend legislation.
In the House, Republican leaders began mounting an offensive last week built around four key principles, as Boehner outlined Monday:
- Giving states more flexibility to "create their own innovative reforms."
Republicans wouldn't bar insurers from denying coverage for pre-existing conditions, as Democratic legislation would, but they'd provide financial incentives for the private marketplace to create high-risk pools.
House Republican leaders fear that putting sicker consumers in with lesser risks could make coverage more expensive for the better risks. By encouraging high-risk pools, people with long medical histories would still be able to get coverage.
- Revamping medical malpractice laws to make it harder to bring what Boehner called "junk lawsuits." Republicans have long sought changes in medical malpractice laws, but Democrats traditionally have blocked them and show no inclination to bend this time.
- Permitting families and businesses to buy health insurance across state lines.
- Making it easier for employers, individuals and small businesses to set up risk pools.
Under one scenario, a small business that operates in different states could draw customers — and thus pool risks — from all states where it conducts business. Currently, such pools are subject to the rules and regulations of each state, which critics see as burdensome.
The Republican effort faces huge hurdles. There isn't yet a firm estimate of how much the entire plan would cost, nor is there a Congressional Budget Office estimate of how many people the Republican provisions would cover.
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