US Republicans eye health plan should court overturn reform

Sun Apr 22, 2012 8:00am EDT

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* Republicans pledge new health plan if Supreme Court acts

* New legislation could aid party's election year aims

* Aides see step-by-step approach on health issues

By David Morgan

WASHINGTON, April 22 (Reuters) - Republicans in Congress are getting ready to answer an election-year question that has dogged the party's campaign for months: How would it replace President Barack Obama's healthcare law if the measure is overturned or repealed?

House Republicans are working to create a legislative blueprint they can sell to voters after the Supreme Court rules on Obama's Patient Protection and Affordable Care Act, the nation's most sweeping healthcare legislation since Medicare and Medicaid in the 1960s.

Lawmakers and their aides say a Republican plan would focus on controlling healthcare costs and allowing people to retain coverage while changing jobs. They will avoid Obama's comprehensive approach to extend coverage to 32 million uninsured Americans.

The aim is to lay out a prospective agenda for the newly elected political leadership in 2013, based on a "step-by-step" approach consisting of separate bills that address specific problems within America's $2.6 billion healthcare system.

But if the high court justices struck down the entire law, Republicans could try to salvage some of the Affordable Care Act's provisions that are already in force and have proved popular with voters.

Representative Tom Price, an orthopedic surgeon who heads the House Republican Policy Committee, said stopgap legislation could be crafted for 2012 if the court ended health insurance safeguards for young adults and children with pre-existing medical conditions.

"That would present a significant void and vacuum in health policy," Price said. "There will be a need to have some things to fill that vacuum."

But a Senate Republican aide said there would be no need for Congress to act this year if necessary adjustments could be achieved by the administration alone or by industry.

"There's a lot of shadow-boxing going on," said one healthcare industry lobbyist.

Closed-door discussions have not yet turned to specific legislative options, w hich may be drawn from a swath of previously proposed Republican legislation. But some say a consensus between leaders and key committee chairmen could emerge as early as the May 28 Memorial Day holiday, weeks before a Supreme Court ruling widely anticipated for June.

"When the Supreme Court acts, we will be ready with plans that actually work to lower the cost of care and to help people keep the care they want," said Republican Senator John Barrasso, another orthopedic-surgeon-turned-legislator who is Price's policy counterpart in the Senate.


The Affordable Care Act , Obama's signature domestic achievement, introduces new consumer protections and encourages market innovations intended to improve the quality of care while eventually lowering costs.

But 26 states and an independent business group asked the Supreme Court to overturn the law on grounds that it exceeded the federal government's constitutional authority by requiring most Americans to buy health insurance and imposing a dramatic expansion of the federal-state Medicaid program for the poor.

The court's impending decision, which would land in the middle of the 2012 campaign battle for control the White House and Congress, could strike down all or part of Obama's reform act, or leave the two-year old package in place.

Whatever the outcome, the decision is expected to kick off an aggressive new chapter in the election campaign that will spotlight healthcare far more prominently, according to analysts and lobbyists.

There has been no word on whether House Republicans are consulting with the party's presumptive presidential nominee Mitt Romney, who has proposed his own set of market-oriented healthcare reforms and has vowed to kill Obama's healthcare law.

Up to now, Republicans on the campaign trail have chiefly attacked "Obamacare" and vowed to repeal it, leaving them vulnerable to charges the party has no credible reform plan of its own.

"They need something positive. 'Repeal' alone is negative, and people want consequential health reform that solves real problems that are facing them," said Robert Moffitt of the Heritage Foundation, a conservative think tank that has contributed reform ideas to both sides of the partisan aisle.

Moffitt and James Capretta of the conservative American Enterprise Institute advocate an approach they say would make consumers more cost-conscious.

It would move away from the current tax break for employer-sponsored healthcare, in exchange for fixed tax credits that would help cover the cost of individual plans sold in a competitive marketplace. Consumers would have to bear any cost over the fixed tax credits.

In an article titled "How to Replace Obamacare," in the current edition of the quarterly journal National Affairs, the two analysts also call for changing existing laws to protect people with pre-existing conditions and adopting policies that would better encourage reform initiatives at the state level.

Similar ideas and others have been circulating for years in Republican legislative proposals that have never become law.

Some call for insurance reforms allowing individuals to buy insurance from other states or for letting small businesses, churches and civic organizations form new insurance pools.

Proposals also would protect doctors and other healthcare providers from malpractice suits and convert Medicare into a program that provides vouchers to help the elderly and disabled meet the cost of purchasing private insurance.

But some of those ideas have been found wanting in the past.

In 2009, the nonpartisan Congressional Budget Office examined a Republican proposal that sought to allow the interstate sale of insurance, imposed medical malpractice reforms and offered incentives for state-level reforms.

The CBO found the plan would cut the deficit by $68 billion over 10 years, extend coverage to only 3 million uninsured and raise insurance rates for some, including those less healthy.

By contrast, the CBO has said the Affordable Care Act would reduce the deficit by $132 billion through 2019.

The Obama administration is also showing signs of thinking about what to do if the Supreme Court's ruling proves unfavorable.

Officials still say they are confident the Affordable Care Act will be upheld and that their focus is on implementing its provisions. But references to "a plan" have begun to emerge in recent comments by the White House and the Department of Health and Human Services.

"We will eventually, I'm sure, have a plan. But that really isn't where all the time and energy is focused right now," Health and Human Services Secretary Kathleen Sebelius told Reuters after a recent speaking engagement. (Additional reporting by Thomas Ferraro; Editing by Michele Gershberg and Peter Cooney)

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Comments (1)
BJSMD wrote:
The Health Care debate has come full circle. People wish new ideas and might not mind starting from scratch if we can achieve a bipartisan proposal that not only expands health care coverage but actually controls and reforms health care delivery.

Having spent a quarter of a century in the health care trenches I see the terrible waste and inefficiencies on a daily basis.

I am typically a Democrat, but on this issue it does not matter as fixing the broken health care system is American and not party related. I am a physician, but I am not a member of the AMA nor do I espouse the typical AMA stance (my proposal would decrease my income!). What I propose works with the strengths of both parties proposals and deals with criticism of those proposals by the other party.

Republicans do not want to consider a single payer system and Democrats do not want to consider HSA’s. If we think outside the box and creatively we can address the concerns that each party has with those two components and move forward.

Republicans don’t like the single payer public option because they equate it with government running health care. So instead, put the insurance component out to bid regionally amongst the private insurers (competition would be fierce) and then treat the winner as a utility. This would reduce administrative redundancy and profiteering. In essence we create a non-governmental single payer. This satisfies the proponents of single payer efficiencies but deals with the concerns of detractors. You then cannot contend that it is government running medicine. Republicans (and people in general) have not been picking up their pitchforks protesting or railing against utilities. The utility model may be imperfect, but it is MUCH less imperfect than the insurance model and its poor regulation. Insurance is an easy utility as there is little infrastructure and it provides the least critical component of the health care delivery model.

Democrats do not like HSA’s because of the perceived financial exposure of high deductible insurance. However, Republicans rightfully recognize this as a model where personally accountability is paramount. So instead, consider HSA’s where the premium difference between the high and low deductible insurance plans is used to fund HSA’s for individuals. This merely shifts money from the insurers hold to the patients hold, making HSA’s a cash neutral event for the patient at worst (if they use all their deductible) to a cash earning event at best with cost conscious consumerism/ healthy lifestyle changes (if they do not reach their deductible limit).

We then establish the “medical coach”, an individual or organization free of profit motive to advise the patient, if they wish to take advantage of this advice. If not, the patient can still make their own decisions based on their personal needs and desires, to use or conserve their own HSA’s as they see fit.

We will never control costs if we do not control utilization. Utilization controlled internally is called conservationism and utilization controlled externally is called rationing. Nobody wants rationing. The indemnity business model undermines the reward to the patient for controlling utilization, but instead rewards the insurers. Creatively structured HSA’s reward the patient for controlling utilization without the typical downside potential.

I hope that as the health care debate seeks “new” ideas, that you will pass this business model on to our elected officials and your readership as a truly bipartisan proposal. California Senate candidate Tom Campbell had incorporated many of these principles into his health care platform and last Fall asked my input for his final mark-up (you can read that on the website referenced below).

The web site is a way for you to reference the plan in more detail and pass it on to your colleagues more easily. Google “theintelligentHSA” to access it.

Please assist me in finding a spotlight for this model in the current debate. Our politicians have been asking for alternative models rather than just criticisms and I am offering one. If it does not survive the public scrutiny that is fine, but at least let it be discussed.

Both Democrats and Republicans would be well served in reading the section in the position paper entitled “Labor, Business and the Intelligent HSA”

Apr 23, 2012 11:32am EDT  --  Report as abuse
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