http://dyn.politico.com/printstory.cfm?uuid=BCA7E946-AA9E-4E7D-836B-B64A9F84F21B A GOP Senate could take on Obamacare — but not repeal it
By: Jennifer Haberkorn
September 15, 2014 05:10 AM EDT
A Republican-controlled Senate cannot repeal Obamacare, no matter how fervently GOP candidates pledge to do so on the campaign trail this fall. But if they do win the majority, Senate Republicans could inflict deep and lasting damage to the president’s signature law.
Republicans are quick to say they are not yet measuring the proverbial drapes. But they are taking the political measurements of repealing large parts of the health law, considering which pieces could be repealed with Democratic support, and how to leverage the annual appropriations and budget process to eliminate funding or large pieces of the law.
Initial targets are likely to include the medical device tax, the individual and employer mandates, the 30-hour workweek to qualify for coverage, and spending on a preventive health fund that Republicans call a slush fund.
The GOP is highly unlikely to get the 60 votes needed to pass most legislation, including full repeal of the Affordable Care Act. And President Barack Obama would veto any bill that significantly hurts the law, which is now covering millions of Americans, during his remaining two years in the White House.
If Republicans win the Senate, Mitch McConnell, the likely majority leader, is expected to hold a symbolic repeal vote early in the new Congress.
“The real question is what comes next,” said Stephen Northrup, a former senior Republican Senate health staffer and now a partner at Rampy Northrup.
Options would range from a targeted repeal of small slices of the law to a broad slash-and-burn strategy. Republicans say that if they win in November, members will decide together how exactly to move ahead. But GOP sources said some strategy discussions already are underway.
Targeted votes would aim at specific vulnerable aspects of Obamacare, like the device tax, which some Democrats may back. The GOP could also use appropriations battles to require the White House to accept some changes or cuts to the law to get other priorities funded, a strategy McConnell has publicly embraced.
And Republicans could use a budget process known as reconciliation, which requires a simple 51-vote majority, to gut significant parts.
“If the Republicans win both the House and Senate, that certainly goes a long way in providing them with new tools they haven’t had in the past,” said former HHS Secretary Mike Leavitt, who studied these options as the leader of Mitt Romney’s transition team in 2012.
Republicans are already eying the specific pieces of Obamacare that might tempt enough Democrats to vote with them to hit that 60-vote mark. Even some liberals have concluded that the twice-delayed employer mandate was poorly designed.
“There are bills that have passed the House with big bipartisan votes that I believe we can get Democrats on board to support in the Senate, because they are positions that are really important for the American people,” Sen. John Barrasso of Wyoming, chairman of the Republican Policy Committee, said in a recent telephone interview.
The targeted bills could still face an Obama veto, which would be virtually impossible for the GOP to override. And surgically removing the most unpopular pieces of the law while leaving other pieces intact could create a whole new set of problems. For instance, protecting people with pre-existing conditions, which is popular, while scrapping the individual mandate, which is unpopular, could send premiums soaring.
Leavitt warned that Republicans have to be able to speak about how they would cover uninsured Americans in a way that is more ideologically aligned with their principles. Polls show the health law remains unpopular, dramatically so with the Republican base. Yet millions of Americans are now getting covered, many with government subsidies.
“It’s going to be important that members remember that people don’t like Obamacare or the Affordable Care Act, but they do want reform,” he said. “The position of the party cannot be one that appears to lack the compassion that people need health care.”
Some conservatives are exploring the idea of removing “repeal” from the GOP mantra. Avik Roy, a conservative health policy expert, has outlined a plan in which Republicans significantly change the ACA to make it more free-market oriented and state-based. But his plan doesn’t embrace the politically unpopular position of taking away consumers’ newfound insurance. But that discussion is still mostly among policy experts, not on the Hill.
Republicans have not yet come to consensus on how to replace the law and articulate their own health vision.
“I think we ought to also spend more time on the replacement side,” Ohio Sen Rob Portman said at a recent breakfast sponsored by The Christian Science Monitor. “Let’s replace it with something that does deal with a very real problem in our health care system, and that is the increased cost and the lack of coverage.”
“In the past, the attitude has been 100 percent or nothing — repeal or nothing,” said Tevi Troy, president of the American Health Policy Institute and a former adviser to Romney and former President George W. Bush. “The longer the law is in effect, the less likely a 100 percent strategy rules the day.”
