Republicans take small steps toward an Obamacare alternative

Republican leaders in the House are trying to build support among their members for a Republican alternative to Obamacare. The problem is in deciding what that should be.

For the second time in less than a year, the US House of Representatives has passed a measure to delay the penalty for Americans who fail to comply with the individual mandate to buy health insurance under the Affordable Care Act. It is the 50th Republican attempt to repeal or undermine the act, according to the count of House minority leader Nancy Pelosi (D) of California.

But now House Republicans also want to be “for” something in health care. That’s why GOP leaders are trying to build support among their members for a Republican alternative health care plan. They’ll still attack Obamacare, but they want to show voters why Republicans deserve to control both houses of Congress come November, and they believe a proactive approach to health care can help them.

There’s only one problem – and it’s a predictable one. The House Republicans can’t agree on a plan, at least not yet.

Opinions diverge on whether to put forward a comprehensive bill (that, after all, is one of their key criticisms of Obamacare – its massiveness), or whether to put forward smaller, more targeted bills that have broad support among GOP members. For example, one bill might address insurance portability across state lines, while another might reform medical liability laws. Meanwhile, several House Republicans have already drafted health care bills.

Other Republicans suggest taking the GOP message on the road with charts and graphs, as Rep. Paul Ryan (R) of Wisconsin did with his budget ideas, according to Roll Call. Still others think taking a proactive position is a waste of time, since even if Republicans did take both houses this fall, they would still have to contend with President Obama’s veto pen.

To help herd this famously divided caucus, House leaders circulated a single sheet of “standards” to replace Obamacare at their GOP retreat at the end of January. The principles, though, are so general that it’s hard to conceive of anyone – even Democrats – objecting to them.

The first paragraph of the mission statement, for instance, says: “We believe all Americans should have access to the best health care and the most affordable coverage in a way that works best for them and their families.”

The next paragraph is a bit more pointed, stating that Americans should be able to “choose the patient-centered health care they want” – a swipe at Mr. Obama’s broken promise that if you like your doctor, you can keep your doctor, and if you like your plan, you can keep it. (Obama has now extended the time that people can keep plans they were denied under the new law).

The GOP’s new health care guidelines “are broad and vague enough so that everybody can agree with them,” says John Pitney, an expert on Congress who teaches at Claremont McKenna College in California. “Once you start talking details, you’re talking tradeoffs, and that’s where the trouble starts.”

Which explains why Republicans are not giving up the attack-Obamacare strategy. Polls show the majority of Americans oppose the law, despite improvements of the HealthCare.gov website and various adjustments by the administration.

Indeed, 27 nervous Democrats joined in Wednesday’s 250-to-160 vote to delay the individual mandate penalty for one year. Last July, when the House passed a similar bill, 22 Democrats voted for it. Individuals who don’t have required health insurance in 2014 face a penalty of $95 or 1 percent of income, whichever is higher.

Republicans argue that if businesses can enjoy a delay of the employer mandate penalty – as granted by the Obama administration – then individuals ought to get a delay, too. “It is only fair that hard-working taxpayers are given the same treatment as businesses,” said the bill’s co-sponsor, Lynn Jenkins (R) of Kansas, on the House floor Wednesday. Democratic leader Pelosi argues that delaying the penalty for the individual mandate – the heart of the law – would cause premiums to go up. The entire issue is clouded by the question of whether the IRS even has the resources to enforce the individual penalty for 2014.

Obama says he’ll veto the bill if it gets to his desk (it won’t), but this is not the last of the anti-Obamacare bills that House Republicans plan to bring up. Also expected this month is legislation targeting the law’s definition of full-time work as 30 hours per week. (The GOP wants to change it to 40 hours, arguing that the lesser definition removes incentives to work). Another bill is expected to address cuts to Medicare Advantage, a private insurance alternative for seniors.

“As we continue to work to finalize our Obamacare replacement plan, we will also act to highlight and address the serious consequences of the law,” wrote House majority leader Eric Cantor (R) of Virginia in a recent memo to members.

Based on the difficulty of coming up with a replacement, attack may be their only alternative.