GOP set to assail healthcare law and seek alternatives

Civility gets its first test in the House since the Tucson shootings in a debate over repeal of Obama's healthcare overhaul.

By Noam N. Levey and James Oliphant, Washington Bureau

January 18, 2011

Reporting from Washington

Preparing to reengage with President Obama, House Republicans have set themselves a more ambitious goal than simply wiping out the sweeping healthcare overhaul signed into law last March.

When they take up the much-anticipated repeal resolution Tuesday and Wednesday, GOP lawmakers also will begin crafting an alternative with the goal of reducing insurance premiums, expanding coverage, preserving Medicare and holding down taxes.

And while they will be mindful of the call for changing the tone of debate after the attempted assassination of Rep. Gabrielle Giffords, they also are preparing for their overriding task of the next 22 months: dislodging Obama from the White House.

He is now more formidable than he was immediately after the Republican electoral victory in November, thanks to a productive lame-duck congressional session and his actions after the Tucson shootings. More than 3 in 4 Americans approved of Obama's response, according to an ABC- Washington Post survey released Monday, his highest rating on a single issue during his presidency.

Incumbents can't be unseated with praise. "If you favor civility, then you favor the status quo," said John Geer, a Vanderbilt University political scientist. "When you want change, first you have to say what's wrong. You have to go on the attack."

That was demonstrated last year when "tea party" anger — much of it directed at the Democratic healthcare overhaul — helped tip the House into Republican hands. GOP leaders vowed to "repeal and replace" the law. They do not have the votes in the Senate to do that, but they are determined to use a House vote to redeem their campaign promise, and to create an alternative proposal that will enable them to keep healthcare alive as an issue into 2012.

"It's more than just repeal," said Rep. Fred Upton (R-Mich.), the new chairman of the House Energy and Commerce Committee. "We recognize that there are reforms that are needed. We're not going to just sit on our hands and do nothing."

The GOP will face a challenge as daunting as Obama did: reconciling the difficult — and politically sensitive — trade-offs that come with trying to provide more and better healthcare while also controlling costs. That balancing act is one of the reasons Obama's healthcare law is so complicated. And it explains in large part why GOP leaders never produced a comprehensive alternative during the debate over the Democratic legislation or the 2010 congressional elections.

The GOP also faces a stark comparison. Previous Republican efforts at healthcare reform were projected to leave 52 million Americans uninsured in 2019. By contrast, the Obama law is expected to reduce the number of uninsured to 23 million.

The Republican plan, unlike the Obama overhaul, did not include an unpopular mandate requiring Americans to buy health insurance. But Republican lawmakers have not indicated how they plan to expand coverage, a task that even conservative healthcare experts say could be a major challenge for the party.

"In a time where we don't have excess funds, looking to solve the problem of the uninsured may not be an easy sell," said Nina Owcharenko, director of the Center for Health Policy Studies at the Heritage Foundation.

So far, senior Republicans are remaining tight-lipped about how or when they will deliver their vision of something better.

"Knocking down the building is a lot easier than building something to replace it," said Dean Rosen, a Republican healthcare lobbyist and onetime aide to former Senate Majority Leader Bill Frist. "It takes a long time. … Republicans understand this."

The GOP effort begins this week with a short resolution directing four House committees to develop legislation meeting 12 criteria, among them: lowering premium costs, assuring access to coverage for people with preexisting conditions and increasing the number of insured Americans, all without raising taxes.

According to GOP officials, Republican lawmakers will draw heavily on legislation they developed in the fall of 2009 as House Democrats were putting the finishing touches on their proposed overhaul.

That plan, which unified staples of GOP healthcare policy from years past, built on a longtime conservative belief that reduced regulation is the best path to controlling costs.

GOP leaders also showed that it was possible to slow the rise in insurance premiums by allowing insurers to avoid mandates in some states to cover services such as maternity care, cancer screenings and mastectomies.

Although premiums still would have increased by 2016 under the GOP plan, one analysis found, the increases for small businesses would have been 7% to 10% less than without the plan.

That analysis was by the nonpartisan Congressional Budget Office.

For individuals who buy insurance on their own, rates would have been 5% to 8% lower than without the plan, the office estimated.

The savings showed the plan was "a common-sense, step-by-step plan that will lower premiums," Rep. John A. Boehner (R-Ohio), then the House minority leader, said at the time.

But that accomplishment did not come without other costs.

Deregulating insurance could make health insurance more expensive for sick Americans, even if it were more affordable for healthy people, according to the budget office, which both parties rely on to assess the effects of proposed legislation.

Budget analysts also estimated that the quality of the coverage that many Americans had could erode as insurers offered fewer benefits.

GOP leaders demonstrated they could craft less costly health legislation that does not require new taxes or cuts in Medicare spending. Their 2009 bill included just $61 billion in new spending over 10 years, compared with more than $900 billion for the health law Obama signed.

But Republicans offered little help for low- and moderate-income Americans who are struggling to pay their premiums. Premium subsidies are the single largest expense in the law that Obama signed.

For now, House Republican leaders say, they need time to develop their alternative.

"We want to do replacement in a legitimate process," said Rep. Peter T. King (R-N.Y), a leader of the repeal effort.

At the same time, the congressional comity following the Tucson shootings appears to be waning. A proposal by Sen. Mark Udall (D-Colo.) that members of Congress not segregate themselves by party during Obama's upcoming State of the Union address is getting only lukewarm support.

Rep. Steve King (R-Iowa) wasn't excited by the thought of sitting with Democrats during the president's address.

"I get a little uneasy with the idea that political rhetoric has anything to do with the tragedy in Tucson. It did not. There's not a shred of evidence," he said Friday. "So what are we trying to fix here?"

Paul West in the Washington bureau contributed to this report.

noam.levey@latimes.com

joliphant@latimes.com