As Health Law Cements Its Place, G.O.P. Ponders How to Attack
With
more than two million Americans poised to be covered under the
Affordable Care Act, Republicans opposed to the law are considering
several ideas for how to proceed.
By JONATHAN WEISMAN
Published: December 26, 2013
WASHINGTON — With the first enrollment deadline now passed, Republicans who have made the repeal of President Obama’s health care law their central aim are confronting a new reality: More than two million Americans are expected to be getting their health insurance through the Affordable Care Act come Jan. 1.
The enrollment figures may be well short of what the Obama
administration had hoped for. But the fact that a significant number of
Americans are now benefiting from the program is resulting in a subtle
shift among Republicans.
“It’s no longer just a piece of paper that you can repeal and it goes
away,” said Senator Ron Johnson, Republican of Wisconsin and a Tea Party
favorite. “There’s something there. We have to recognize that reality.
We have to deal with the people that are currently covered under
Obamacare.”
And that underscores a central fact of American politics since Franklin D. Roosevelt signed the Social Security Act during the Depression: Once a benefit has been bestowed, it is nearly impossible to take it away.
Republicans are considering several ideas for how to proceed. Mr.
Johnson argued that Congress should do away with the mandate that most
people obtain insurance, but not the online exchanges at the heart of
the law. Instead, he said, the options in the marketplaces should be
augmented by other choices that fall short of the law’s coverage
standards, such as catastrophic health plans. (Many policy analysts and
insurance companies say such a move would not work, because the mandates
are essential to delivering a diverse pool of uninsured people.)
Senator Lindsey Graham, Republican of South Carolina, said that health
care strategy was the hottest topic of debate in closed-door political
sessions.
“The hardest problem for us is what to do next,” Mr. Graham said.
“Should we just get out of the way and point out horror stories? Should
we come up with a mini Contract With America on health care, or just say
generally if you give us the Congress, the House and the Senate in
2014, here’s what we will do for you on multiple issues including health
care? You become a more effective critic when you say, ‘Here’s what I’m
for,’ and we’re not there yet. So there’s our struggle.”
Senator Kelly Ayotte, Republican of New Hampshire, said she was teaming
up with Democrats on a host of incremental changes to the law, such as
expanding health savings accounts and repealing a tax on medical
devices. And other Republicans are wondering aloud how long they can
keep up the single-minded tactic of highlighting what is wrong with the
law without saying what they would do about the problems it was supposed
to address.
Representative Tom Price, Republican of Georgia, a physician and a
prominent conservative voice on health care, is pushing what he calls
the Empowering Patients First Act, which would repeal the health care
law but keep its prohibition on exclusions for pre-existing conditions
in private health insurance.
The bill would allow for insurance to be sold across state lines, push
small businesses to pool together to buy insurance for their employees,
expand tax-free health savings accounts, cap malpractice lawsuits, and
offer tax credits of $2,163 for individuals and $5,799 for families to
buy health plans.
The American Action Forum, a conservative advocacy group run by Douglas
Holtz Eakin, a former director of the Congressional Budget Office,
analyzed the Price plan this month. The group concluded that it would
lower insurance premiums by as much as 19 percent by 2023, while leaving
the ranks of the uninsured about 5 percentage points higher than the
Affordable Care Act would by then.
Representative Paul D. Ryan of Wisconsin, the Republican
vice-presidential nominee in 2012 and a possible 2016 presidential
hopeful, is preparing his own health insurance plan for release early
next year.
Mr. Ryan’s plan will build on one that he and Senator Tom Coburn,
Republican of Oklahoma, introduced in 2009, according to aides familiar
with it. The proposal, called the Patients’ Choice Act, would have
eliminated the tax break for employer-provided health care to finance a
tax credit of about $5,700 for families and $2,300 for individuals.
States would have been asked to create insurance marketplaces like the
ones many have created under the Affordable Care Act.
As with the Obama health care law, the Ryan proposal demanded that
insurers meet minimum standards of coverage and be prevented from
excluding the sick. But instead of mandating penalties for failing to
buy insurance, the approach would have automatically enrolled people
unless they opted out.
Mr. Price said on Thursday that he was “cautiously optimistic” that he,
other lawmakers and House Republican leaders could meld the different
approaches into one alternative health plan to take to voters — and
possibly the House floor — in the 2014 election season.
“It’s the minority’s responsibility to provide a contrast,” he said.
“It’s important that we put forward an upbeat, positive proposal, so the
American people know there is an alternative.”
Whether voices like Ms. Ayotte’s or Mr. Johnson’s will ultimately
prevail is unclear, given the deep opposition among rank-and-file
Republicans. Mr. Graham said that Republicans would probably get away
with denouncing the Affordable Care Act through the midterm elections,
but that by 2016 they would need to have a fully formed alternative.
White House officials acknowledge that the administration needs to focus
on making sure all those who enrolled in health plans actually have
coverage on Jan. 1. HealthCare.gov received two million site visits on
Monday, the official deadline for coverage starting Jan. 1, and the
insurance call center took more than 250,000 calls, said Julie Bataille,
a spokeswoman for the Department of Health and Human Services. More
than 129,000 people left emails on Monday after finding the website
jammed with traffic, and activity remained brisk on Tuesday for those
taking advantage of a 24-hour extension.
“Millions of people visited the state and federal marketplaces this week
to purchase private health plans,” said a White House spokeswoman, Tara
McGuinness. “The final tallies are being rounded up, but we believe the
deadline encouraged decision-making for hundreds of thousands of
families who will have access to care in the new year.”
State-run exchanges had a similar crush. Almost 26,000 people signed up
in New York State on the last enrollment day. California enrolled
27,000, and Washington State 20,000. Connecticut beat its expectations
with 6,700 new sign-ups.
Some of those rushing to enroll are bound to find problems in January as
private insurers struggle to line up federal and state website
enrollment with actual policies, a White House official said. And
attitudes toward the law are not going to change overnight.
But if Mr. Obama’s approval rating on health care is tepid, Congress’s
is abysmal. Just 19 percent of Americans approve of the way
congressional Republicans are handling health care. Still, a New York
Times/CBS News poll
this month showed that nearly two-thirds of Republican respondents
wanted to have the Affordable Care Act repealed, and most Republican
lawmakers are appealing to those constituents.
“A few million people are buying a product that has features they don’t
want, paying more for it than they should have to pay for it because
they had to buy it through this government-mandated mechanism,” said
Senator Patrick J. Toomey, Republican of Pennsylvania. “I don’t think
that changes anything fundamentally at all.”
Asked what should be done with the millions of people getting health
care through the law, Senator Dan Coats, Republican of Indiana, said,
“Call the White House and ask them.”
COPY http://www.nytimes.com/
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