Even as some of the first pieces of President Obama's health care reform legislation take effect, Republicans in Congress and conservative activist groups are still working to repeal or at least rewrite major sections of the legislation.
Rep. Steve King, Iowa Republican, is circulating a petition that would force an up-or-down vote in the House of Representatives on repealing the vast bulk of the estimated $940 billion, 10-year legislation the Democratic-controlled Congress passed this spring.
The petition had 80 signatures as of Thursday - the same day the White House formally launched HealthCare.gov, which officials described as a "one-stop shopping" place for health insurance. Other parts of the law, including a new 10 percent excise tax on indoor-tanning services and a new stopgap program to cover Americans with pre-existing health conditions who can't get private-sector coverage, also went into effect Thursday.
A second House "discharge" petition to force a vote over the opposition of the Democratic majority, offered by California Republican Rep. Wally Herger, calls for a full repeal and the passage of a substitute GOP plan.
Support for Mr. King's proposal sharply increased this week as House Minority Leader John A. Boehner of Ohio and Minority Whip Eric Cantor of Virginia joined the effort and the conservative Club for Growth informed lawmakers that the group would "score" their position on its influential legislative ranking.
"The American people asked Congress and President Obama not to pass the massive health care overhaul, and they were ignored," said Mr. Boehner and Mr. Cantor. The two also said they could support Mr. Herger's alternative.
The Republican Study Committee said Thursday at least five other straight repeal bills are in the House, all needing 218 signatures to advance.
The Heritage Foundation's newly launched independent-advocacy wing, Heritage Action for America, also has a repeal effort. The group notes that most of the legislation's major changes will not occur until 2013 and 2014 so there is still time to "bring the heat" and tell lawmakers "why you support a full repeal."
Club for Growth spokesman Mike Connolly said if the repeal effort makes progress, the group would also expect lawmakers who voted against the legislation to "follow through and ultimately co-sponsor legislation in the next Congress."
Though the economy and jobs will likely remain the key issues during the midterm elections, some Republican candidates - including Senate hopefuls Marco Rubio in Florida and Pat Toomey in Pennsylvania - have made repeal an important part of their campaigns.
Democrats, citing recent polls showing an uptick in popular support for the health plan, have at times appeared eager for a clash over repealing the health program, predicting the GOP blanket opposition will backfire at the polls.
"Some folks on the other side of the aisle ... have said theyre going to run on a platform of repeal," Mr. Obama said last month. "They want to go back to the system we had before. ... Would you want to go back to discriminating against children with pre-existing conditions?"
The Democratic National Committee has already aired a 60-second cable television ad titled "We Can't Afford to Go Back" slamming the repeal effort.
Despite an endorsement from the American Medical Association, many U.S. doctors say they still do not support the legislation.
A coalition of doctors urged Congress on Tuesday to protect them against provisions they fear will hurt their businesses and lower the quality of care of Americans.
Among the group's primary concerns is that practicing doctors will be excluded from the law's treatment-recommendation panel and that the new Independent Payment Advisory Board wields too much power and will make decisions based exclusively on cost.
"We're worried about the [payment] board making decisions without considering a patient's access to care and the effectiveness of care," said Dr. Laxmaiah Manchikanti, chairman of the American Society of Interventional Pain Physicians.
The 18-member board, include 15 full-time members, will make recommendations on Medicare and other health care costs without congressional approval. For example, the recommendations go into effect if Congress votes against them, but the president vetoes the vote and Congress cannot get the two-thirds majority vote to overturn the veto.
"We'll have no recourse in Congress," Dr. Manchikanti said.
In group's joint-effort with the North American Neuromodulation Society, nearly 200 doctors came to Capitol Hill to call upon such top Republican Party lawmakers as Louisiana Sen. David Vitter and Minnesota Rep. Michele Bachmann.
However, the most solid promise Tuesday perhaps came from Sen. Sherrod Brown, a Ohio Democrat who voted for the multi-billion dollar reform legislation.
Mr. Brown vowed to circulate a petition asking the House and Senate to put working doctors on the treatment board, officially known as the Patient Centered Outcomes Research Institute. The 40-member nonprofit includes the National Institutes of Health director and 17 appointees by the General Accounting Office.
"A letter doesn't get it accomplished, but it's a start," said Dr. David S. Kloth, a Connecticut doctor and ASIPP director.
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