House Republicans didn’t just uphold the first half of their “repeal and replace” mantra for President Obama’s signature health-care reform legislation Wednesday. They voted to repeal the measure amid a hail of rhetorical fire and brimstone, hollering one of their chief November rallying cries before a 244-to-185 vote with but five Democrats joining a united Republican front.
So Republicans have proved they’ll cast out the president’s health-care law when given the opportunity – the vote marked the second full repeal by the House and the 31st time the House has voted to defund, roll back, or otherwise hack away at some part of the 2010 health-care reform.
But “repeal” is only half the rallying cry. How will the Republicans “replace” what they deride as “Obamacare”?
For Republicans, that’s about half the point.
As they battle toward the November elections, congressional Republicans aren’t going to lay out a specific, unified proposal for replacing Obama’s health-care legislation. Instead, they will allow individual members to run on the ideas they think are best. Then, with the election in the rearview mirror, conservatives expect that they’ll be able either to repeal or to reopen discussion of the health-care law because of its impact on the nation’s finances.
And that’s when they’ll really get back into the fray with specific proposals.
For now, however, the GOP playbook works like this. First, cite your principles.
“What we’ve said is we believe in the principles that Americans hold dear as it relates to health care,” said Rep. Tom Price (R) of Georgia at a health-care discussion on Tuesday sponsored by Republican groups Crossroads GPS and American Action Network. Those principles are “affordability, accessibility, quality, innovation, and choices."
Second, whack your Democratic adversaries for "Obamacare," arguing that a bad legislative process led to terrible, economy-stalling legislation.
“We’re not going to repeat the mistake of the other side and that is to decide what ought to be done behind closed doors and then shove it down the throat of Congress and the American people,” said Mr. Price, an orthopedic surgeon.
That race to jam a bill through Congress, Republicans will argue, produced a measure so massive, unwieldy, and poorly thought-through that it is weighing down the American economy with regulations and policies that simply don’t work. Such an argument ties health-care reform tightly to the issue that will almost certainly decide the November vote.
“The election is going to be about the economy," said Sen. John Barrasso (R) of Wyoming, an orthopedic surgeon who spoke with Price on the health-care panel on Tuesday. "The president’s health-care reform package is terrible for the national economy and for taxpayers."
“You’re not going to see a 2,700-page health-care law coming from us,” he added. “I just don’t think government does big things well. I’m much more interested in a step-by-step, common-sense approach.”
And third, Republican members will have an arsenal of established conservative ideas to choose from when asked for specifics, even though they won’t have a united, overarching policy plan. Price has his Empower Patients First Act. Senator Barrasso has sponsored the State Healthcare Choice Act. And a group of the House’s most conservative members, the Republican Study Committee, circulated a list of more than 200 measures sponsored by members over the past 18 months.
And those are just the contemporary proposals, coming in addition to untold volumes floated by conservative think tanks and policy groups over the years.
“There are countless proposals and each individual in their own district, in their own explanation to their constituents, is easily able to say, ‘These are the things that I believe, these are the kinds of bills that I support,’ ” Price said.
Republican strategy is informed by Democrats’ experience with health-care reform in two ways. First, they argue that having creamed congressional liberals in the 2010 elections with "Obamacare" as their primary weapon, they aren’t about to let Democrats shift the conversation from health-care reform in the runup to the 2012 vote.
Next, they say that when they’re running Washington, they will look for health-care answers from both sides of the aisle.
There’s “a recognition we have to do this in a bipartisan fashion. I believe that all big reforms have to be bipartisan to be successful,” said Douglas Holtz-Eakin, a top adviser to John McCain’s presidential campaign in 2008 and president of the American Action Forum. “And one of the reasons is they’re informed by all the ideas, which span the spectrum. But in addition, [reforms] have a political durability if both sides buy in. The Affordable Care Act is a living testament to doing it wrong. It was done in a partisan fashion and it has come apart as a result.”
One way or the other, Republicans believe, they’re going to get another shot at health-care reform in 2013 because of a somewhat unlikely catalyst: the so-called fiscal cliff.
With the US needing to grapple with some $560 billion in spending cuts and tax increases come January, Congress will be forced to look at the long-term financial health of the United States like never before. With spending on entitlement programs like Social Security and Medicare already consuming some 60 percent of the federal budget, according to the Congressional Budget Office's long-term outlook, these concerns will have to be in lawmakers' budgeting crosshairs if they hope to improve the nation's future financial health.
At that juncture, the role of health-care costs in entitlement programs will come into play, raising the possibility of revisiting the law, said several conservative analysts at the Crossroads/AAF discussion.
“If we don’t do something [about the nation’s financial situation], the world ends, and that means [Democrats] will have to talk about the budget, these spending programs, and that means they will have to talk about health-care reform, whether they want to or not,” Mr. Holtz-Eakin said.
Conservatives could get a more direct boost from Congress’s budget scorekeepers in the weeks to come. After the US Supreme Court ruled that states can opt out of the Medicaid expansion in the law, the Congressional Budget Office may have to increase the law’s impact on the national debt, when it releases its new analysis of the law during the week of July 23, according to Pete Davis of Davis Capital Investment Ideas.
That would put the law more squarely into the context of the type of long-term debt and deficit reduction discussion that many lawmakers from both parties foresee in the lame-duck session of Congress after November’s elections and into the next congressional session.
In 2013, then, Republicans will be ready for a second reckoning in the health-care debate.
“For many years, Republicans have thought ‘Health care, I’m scared to death of this issue.... I don’t want to talk about health care,’ ” said Gracie Marie Turner, president of the conservative health-care reform organization the Galen Institute. “I think there’s an awakening among conservatives ... [that] you’ve got to be able to tackle this.”