WASHINGTON, March 20 As the U.S. Supreme Court prepares to hear legal challenges to President Barack Obama's healthcare overhaul next week, Republican lawmakers are weighing options for repealing the law or even replacing it with a plan of their own.
In fighting the 2010 Patient Protection and Affordable Care Act that will extend health coverage to millions more Americans, Republicans have not offered a definitive alternative.
But should the entire law get struck down by the court, it would reignite the debate over whether a comprehensive plan or step-by-step approach is best to fix a healthcare system that many lawmakers from both parties agree is too expensive and leaves too many people without affordable medical coverage.
Here is a look at how the Republican strategy is likely to unfold, according to party lawmakers, their congressional aides and political analysts:
Q. Why not offer an alternative plan now?
A. Anything Republicans advanced would become a political target for Obama's Democratic Party ahead of Nov. 6 national elections. Many in Congress don't expect Republicans to put forward a proposal until after the Supreme Court rules in late June. What they do will depend largely on how the court rules. It could strike down the entire law, or focus exclusively on the core question of whether the requirement that all Americans buy health insurance is constitutional.
Meanwhile, Republicans are pressing their attack against the law they dismissively brand as "Obamacare." They are putting forward a series of measures aimed at repealing parts of it. None is expected to pass the Democratic-led Senate. But voter doubts about the law helped Republicans take control of the U.S. House of Representatives in 2010 and it remains a major issue for them in this year's elections. Republicans planned to actively focus on the healthcare law in the days leading up to its two-year anniversary on March 23 and the Supreme Court oral arguments the following week, aides said.
Q. What if the Supreme Court strikes down the entire law?
A. Most likely Republicans would put forward a limited plan to address insurance and healthcare costs along the lines of an alternative offered by House Ways and Means Committee Chairman Dave Camp during the 2009 debate over Obama's healthcare law. That bill aimed to increase competition among health insurers, which are regulated by states, by allowing them to sell policies across state lines. It also would encourage businesses to pool together to purchase medical coverage for their employees.
Republican Representative Tom Price, a physician, is a lone voice within the party who is encouraging a comprehensive approach without the mandate. He warns of the dangers of unintended consequences by tinkering with the system. Price's plan includes many of the ideas put forward in Camp's plan. It also aims to increase health coverage through tax credits for low-income people and gives those with Medicare and other government health plans the option of receiving a tax credit to help purchase private coverage. It also calls on states to voluntarily set up Internet-based insurance purchasing sites to help consumers shop for, and compare, coverage plans.
Q. What if the Supreme Court just strikes down the mandate requiring everyone to purchase insurance?
A. Striking down just the mandate to purchase insurance will most likely intensify calls to repeal the entire law. Insurance premiums could soar since insurers are barred under the law from turning away customers with pre-existing conditions, but will not be able to buffer their exposure through premiums paid by healthier individuals who may opt out of coverage.
Republicans who have been fiercely opposed to the law are unlikely to cooperate with any Obama administration efforts to modify it, especially in an election year. They may put forward a proposal to encourage more plans, known as high-risk insurance pools, in individual states to cover people with pre-existing conditions.
Q. What if the Supreme court upholds the Obama healthcare law?
A. Expect Republicans to continue targeting various provisions of the law at least through the November elections. Already they have succeeded in forcing some changes, including repeal of a provision that would have imposed more tax reporting requirements on small businesses. Republicans have succeeded also in pushing through measures requiring the government to reclaim greater amounts of insurance subsidy overpayments than was originally included in the law. House Republicans are pushing through legislation to do away with an independent payment advisory board for Medicare and to eliminate a new tax on medical devices that was put in place to help cover the cost of the new law. (Editing by Michele Gershberg and Lisa Shumaker)