The GOP push to replace Obamacare is stuck in neutral, with Republicans deeply fractured over what to do and fearful of giving President Obama and his Democratic allies an easy target ahead of November's elections.
House Republican leaders vowed earlier this year to craft and vote on a bold proposal to fulfill the second part of its repeal-and-replace approach to Obamacare. But those plans have been derailed by rank-and-file lawmakers who say they want to see tweaks, but don't want to vote on sweeping alternatives.
"I don't know if we can," said Rep. Michael C. Burgess, a Texas Republican who instead has focused on small changes such as giving preferential tax treatment to health care savings so people can cover their Obamacare plan deductibles.
"Repeal and replace" was the GOP's mantra beginning with the 2010 "Pledge to America" and continuing through 2012. While House Republicans have held dozens of votes to repeal all or part of the law, they have yet to offer a unified replacement plan.
"How many years ago did Obamacare pass?" Michael Czin, spokesman for the Democratic National Committee, said. "They've had year after year."
But Republicans say doing a broad replacement has become tougher after the immigration debate in the Senate last year, which made "comprehensive" a dirty word in GOP circles.
Republicans also fear that writing a specific plan will give Mr. Obama the chance to switch from defense to offense, particularly if the GOP comes up with a plan that costs less, but does not insure as many people as Obamacare.
"It is absolutely frustrating," Republican strategist Ford O'Connell said. "But, essentially, elections don't lend themselves to pragmatic policy development."
In the Senate, legislative aides said Republicans are reluctant to expend energy on an alternative that will be ignored by Majority Leader Harry Reid, Nevada Democrat. Instead, they said a more practical method is to file amendments to scrap the medical device tax or other parts of the law before putting Mr. Obama's veto pen to test by retaking the chamber in November.
Republican lawmakers said the law cannot be fixed and should be scrapped, but many realize their hopes for repeal are moot until control of the White House changes hands.
"What we'd like to do instead is move in an entirely different direction — step by step — and how fast we can go will depend really on how big our majority is," Sen. Lamar Alexander, Tennessee Republican, told The Washington Times.
For their part, Democrats say Republicans are fixated on repealing Obamacare and are not serious about a replacement.
Most Americans don't believe the GOP has an alternative, according to a May tracking poll from the nonpartisan Kaiser Family Foundation, which found that 61 percent said Republicans "do not have an agreed-upon alternative."
But Republicans get frustrated when pundits and Democrats say they have no health care ideas of their own.
A trio of Senate Republicans released a comprehensive blueprint in January, Louisiana Gov. Bobby Jindal issued his own template in April, Rep. Tom Price of Georgia has a replacement bill, and so does the Republican Study Committee. The RSC legislation even has a majority of House Republicans signed on as co-sponsors.
The plans share key elements. They lend flexibility to state Medicaid programs, extend preferential tax status to people who buy insurance outside of their jobs and let people shop for health policies across state lines, all in a bid to favor market-driven policies over the role of the federal government.
As for a unified plan, Republican leaders say they're still committed to it and working on getting the policy right.
Rep. Diane Black, Tennessee Republican and frequent Obamacare critic, said it is important for the GOP to "articulate their vision" for replacing the law with other reforms.
Lanhee J. Chen, a health policy adviser to GOP presidential nominee Mitt Romney in 2012, said Republicans should focus on a "principles-plus" approach, in which the party trumpets tenets that, although not enshrined in a bill, offer enough "grist" to convince voters that they can govern effectively.
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