With a major Obamacare sign-up deadline past, Republicans are turning their attention to the “replace” half of their repeal and replace strategy, hoping to make up ground lost over the past four years as they seek to show voters that they have an alternative to the president’s health care overhaul.
Retired surgeon Ben Carson sat down with the House Republican health care caucus Thursday to hash out ideas. The doctor urged lawmakers to set some deadlines of their own for writing a plan.
“It doesn’t do any good to have a lot of good ideas but not to get behind one and really push it,” said Mr. Carson, who has been mentioned as a potential Republican presidential contender.
The first enrollment period for Obamacare has ended, and President Obama has claimed success with the sign-ups of 7.1 million Americans in the federal and state health insurance exchanges set up under the law.
Democrats say the final tally means millions now have coverage thanks to provisions that prohibit caps on spending and prevent companies from denying insurance for pre-existing health conditions. They argue that a repeal by Republicans would leave all of those Americans worse off.
Republicans were already under pressure to elucidate how their vision contrasts with that of the Democrats they hope to unseat in November’s midterm elections, and to offer a realistic alternative to Obamacare.
House Speaker John A. Boehner, Ohio Republican, said this week that the party is seeking consensus around an alternative plan.
Louisiana Gov. Bobby Jindal offered one version, which calls for block grants to give states the option of offering subsidized plans to low-income residents on the condition that people with pre-existing conditions are not denied coverage. Three Republican senators offered a comprehensive blueprint in January.
On Thursday, House members, Sen. Rand Paul and Mr. Carson discussed expansion of health savings accounts. Republicans see the model as a practical tool with tax advantages that allow Americans to take control of their own health care spending.
Mr. Carson is leading the Save Our Healthcare project for the American Legacy PAC. He released a set of principles Thursday that he said would promote individual and state flexibility over a top-down approach to health care reform from Washington. A step-by-step plan will follow soon, the political action committee says.
The GOP alternative
The various Republican plans share certain principles. Each would let states take the lead in administering health care programs and covering people with pre-existing conditions through block grants or continuity clauses, rather than taking the Obamacare approach of mandating individuals to acquire coverage to balance risk pools.
“When people say Republicans don’t have a plan, really it’s because they haven’t been paying attention or we haven’t gotten the message out well enough,” said Mr. Paul, a Kentucky Republican and potential presidential contender who attended the Carson meeting.
Mr. Paul said many of the plans offered through Obamacare exchanges have high deductibles, “and you’re going to find thousands of people — hundreds of thousands of people — who are going to complain about how much they have to pay out of pocket. A health savings account would help them.”
It’s doubtful that any of the Republicans’ plans would pass this year because Democrats control the Senate and have rejected all but the smallest of changes to the Affordable Care Act.
Indeed, Democrats say Republicans should get used to Mr. Obama’s overhaul. The health care act, which passed in 2010, has survived a challenge before the Supreme Court and dozens of repeal votes in the Republican-led House.
Mr. Obama and congressional Democrats cheered this week after 7 million Americans selected health care plans on the federal and state exchanges by the Monday deadline. Republicans said it is unclear how many enrollees have paid for coverage.
“While they obsessed over the past, the country moved forward. And now, Republicans have to face the fact that millions of their own constituents, millions of Republicans, are benefiting from health reform in record numbers,” Senate Majority Leader Harry Reid, Nevada Democrat, said Thursday.
A buoyant Mr. Obama, noting the final enrollment numbers, declared Tuesday that “the debate over repealing this law is over.”
“The Affordable Care Act is here to stay,” the president insisted.
Democrats accused Republicans of being choosy in their opposition to Obamacare because a spending plan crafted by House Budget Committee Chairman Paul Ryan, Wisconsin Republican, keeps the law’s tax increases but repeals benefits such as subsides to buy insurance.
“You take that out, they don’t come close to balance,” said Rep. Chris Van Hollen, Maryland Democrat.
Despite protests from top Democrats, dozens of rank-and-file House members have supported bills that change the law or scale back its mandates, reflecting in part Obamacare’s continuing liability as a political issue.
On Thursday, 18 Democrats backed a House bill that changes the law’s definition of full-time work from 30 hours to 40 hours per week, out of concern that employers would have an incentive to cut part-time workers’ hours to less than 30 per week.
Vulnerable Senate Democrats facing re-election this year in right-leaning states also proposed changes after millions of Americans lost their bare-bones health care plans because they did not comply with Obamacare standards.
“If I had to predict, I would say that the Democrats are going to be begging us to fix parts of Obamacare before November,” Mr. Paul said. “And already, I think you’re seeing some of that.”