What would a Republican healthcare bill look like?

There’s no mystery about what Republicans don’t like in healthcare plans winding through Congress.

In floor speeches for weeks, GOP leaders have slammed Democrats for trillion-dollar price tags, tax increases, Medicare cuts to seniors, expansion of government, and the exclusion of minority views, notably their own.

Democrats have disputed these claims, but also made a simpler response: Well, what’s your plan?

This week, even GOP governors, their states battered by surging healthcare costs, joined the chorus. California Gov. Arnold Schwarzenegger Tuesday called on “colleagues on both sides of the political aisle” to move forward on reform. In an opinion piece Monday, Louisiana Gov. Bobby Jindal urged Republicans in Congress to “join the battle of ideas.”

Perhaps they will. House majority leader Steny Hoyer (D) of Maryland and GOP whip Eric Cantor (R) of Virginia plan to meet Thursday to discuss possible areas of agreement. House GOP conservatives are meeting Wednesday with Health and Human Services Secretary Kathleen Sebelius on healthcare proposals.

But Republicans insist that they have been floating ideas for months that Democrats have simply ignored. They claim 37 GOP plans in the House and at least three in the Senate.

(Remember seeing members of Congress waving pieces of paper during President Obama’s speech to a joint session of Congress last month? Those were GOP healthcare proposals.)

So what are the Republican ideas?

Elements of GOP plans include:

• Tax credits to individuals who purchase health insurance on their own.

• Incentives for states and small businesses to band together and offer health insurance at lower costs.

• Tort reform to reduce costly “defensive medicine.”

• Incentives to save through health savings accounts.

• Incentives to promote prevention and wellness.

• Reforms to end discrimination on the basis of preexisting conditions.

• Breaking down barriers to purchasing health insurance across state lines.

Why didn't Republicans write their own bill?

But these proposals have not been cast in legislative language or officially scored by the Congressional Budget Office, so that costs, benefits, and trade-offs are transparent.

In the current partisan climate, GOP sponsors say offering their own comprehensive plan would be pointless. Of the five congressional panels that developed healthcare legislation, only the Senate Finance Committee attempted a bipartisan approach, and even that bid faltered.

“Why don’t we put forward our own 1,000-page bill? Because then with one vote they can defeat it,” says Sen. Michael Enzi (R) of Wyoming, a member of the two panels that worked on healthcare legislation – the Health, Education, Labor, and Pensions Committee and the Finance Committee.

GOP's healthcare vision: light on mandates

What GOP plans have in common are elements to increase competition and defend against government deciding terms of healthcare or insurance.

“You ought to be able to pick your plan as opposed to having Congress dictate,” Senator Enzi adds, noting that Massachusetts – which requires universal healthcare – has 1,200 mandates; Wyoming has 23.

“Congress is going to say what the minimum insurance is that you have and if you don’t like it you pay a fine, and if you don’t pay the fine you go to jail,” he says.

Amendments ignored

As congressional panels drafted bills, Republicans also proposed hundreds of amendments, most of which were rejected.

These included:

• Capping jury awards in medical malpractice lawsuits.

• Blocking health benefits from going to illegal immigrants.

• Preventing taxpayer funding of abortion.

• Requiring a 72-hour period for lawmakers to read the bill before voting on it.

Eight Democrats joined Republicans Tuesday in a call for more transparency and 72 hours for the public to read proposed healthcare legislation before a floor vote.

“At a time when trust in Congress and the US government is unprecedentedly low, we can begin to rebuild the American people’s faith in their federal government through transparency and by actively inviting Americans to participate in the legislative process,” the senators wrote.

Democrats signing the letter to Senate majority leader Harry Reid included Sen. Blanche Lincoln of Arkansas, Evan Bayh of Indiana, Mary Landrieu of Louisiana, Claire McCaskill of Missouri, Ben Nelson of Nebraska, Mark Pryor of Arkansas, Jim Webb of Virginia. Sen. Joseph Lieberman (I) of Connecticut also signed it.

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