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February 7, 2016

GOP Leaders to Huddle on Obamacare Alternative


(Douglas Graham/CQ Roll Call File Photo)

House Republican leaders will meet Friday to begin crafting an alternative to Democrats’ health care law, but they face a slate of challenges from inside and outside the conference to advancing a credible plan.

Majority Leader Eric Cantor, R-Va., will meet privately with relevant committee heads, his staff said. Budget Chairman Paul D. Ryan of Wisconsin, Education and the Workforce Chairman John Kline of Minnesota, as well as Ways and Means Chairman Dave Camp and Energy and Commerce Chairman Fred Upton, both of Michigan, will attend.

Cantor has pledged a vote to not just repeal President Barack Obama’s health care law but also replace it with Republican legislation this year. And although Cantor said  in a memo to members Friday that leaders are continuing “work to finalize” the bill, the process is far from its final stages.

When Cantor announced the legislative push at an annual policy retreat last month, his conference was generally supportive. Yet the Republicans have much work to do to come to an agreement on a single plan to pursue.

That task will fall to Cantor and his top committee chairmen, who will gather the party’s best ideas, build support in their respective committees and craft consensus among the conference writ large, especially factions such as the Republicans Doctors Caucus and the Republican Study Committee.

GOP leaders have been clear that ahead of the 2014 elections, the conference wants to show what it is for, not simply what it is against. Similarly, they want to show that they are not in favor of simply returning to the old health care system, which is viewed unfavorably by the electorate.

But crafting an alternative that can get 218 Republican votes — as few Democrats can be expected to back such a plan — is a tall order.

“What you’re seeing is the conference sort of looking through these various ideas to sort of pull together an alternative, and that’s going to take some time,” said David Winston, a top pollster for Speaker John A. Boehner of Ohio.

Individual members of the House and Senate have introduced legislation to replace the Affordable Care Act, but GOP leaders have yet to endorse one proposal. In the House, Reps. Tom Price and Paul Broun, both from Georgia and both doctors, have separately introduced alternative bills. The Republican Study Committee, meanwhile, touts a bill helmed by Rep. Phil Roe, R-Tenn., and has pushed leadership to start with that text as a framework when crafting a leadership-sanctioned alternative.

A Republican Senate proposal was added to the mix late last month, introduced by Sens. Richard M. Burr of North Carolina, Tom Coburn of Oklahoma and Orrin G. Hatch of Utah.

“There are a lot of really good ideas that have been put on paper already,” RSC Chairman Steve Scalise of Louisiana said recently. “We don’t need to reinvent the wheel.”

The House proposal is likely to include poll-tested measures that have broad agreement in the GOP conference, including allowing the purchase of health insurance across state lines, allowing insurance portability between jobs, expanding access to health savings accounts and limiting medical malpractice lawsuits.

Republican aides note, however, that they have yet to decide whether to move forward with a single bill or several small-bore measures.

Moving a comprehensive bill could be challenging in the conference, especially since one of the main attacks against Democrats’ law was that it is too big and burdensome.

“The GOP is struggling to find the right way to do the wrong thing, to take over the American medicine and health insurance industry,” said Jane Orient, executive director of the right-leaning Association of American Physicians and Surgeons, which has endorsed Broun’s bill.

Yet a smattering of smaller measures might not serve as a credible alternative to the wide-ranging law that is already being implemented and has already insured several million people, eliminated pre-existing condition restrictions and provided a host of other benefits.

If the GOP does succeed in crafting a bill, there are still problems in selling it, GOP aides concede. A Congressional Budget Office score could give Democrats fodder and put their members on the spot.

In 2009, Republicans proposed an alternative to the ACA, and the CBO noted that it would neither save as much money nor cover nearly as many people. Republicans pushed back, but the report opened up attacks from Democrats.

Unlike years ago, however, the law’s rocky rollout will make it easier to make the case for an alternative, said James Capretta, who advised House Republicans on health care alternatives during the recent retreat.

“Whatever the replace plan looks like will be measured against the reality of Obamacare, not what was written down on paper four years ago,” he said.

Yet if Republicans go for a more robust proposal than they did then, they risk alienating their conservatives. Leaders have had limited success adopting the popular ideas in the Democratic health care law in bills Republicans can support.

Last May, Cantor pushed a bill that would help Americans with pre-existing conditions by reallocating money from one of the bill’s funding streams to high risk pools. It had to be pulled from floor consideration after the conference rejected it, partly amid conservative concerns that it didn’t do enough to do away with the law. Aides said at the time that they would bring the proposal back up.

It has yet to be reconsidered.

  • purpleday

    Good. America has been waiting for the GOP plan for five long years. Let the GOP come up with their plan and let the CBO score it. I hope the media will put the GOP plan under the same scrutiny as they have ACA. Let’s compare and contrast the GOP plan with ACA. Pretty good bet GOP plan will not hold a candle to ACA.

  • Political Pundit aka Paul Ryan

    lordy, what a crock.

  • Ryan

    This “alternative plan” line is a weak Hail Mary to try and make up for the negative publicity on the consistent repeal bills. They’ll never come up with anything that will hold water as a viable complete alternative while also earning the approval of the conservative wing of the party. And, of course, repeal support has been pretty much dead since the shutdown. Sooner rather than later, the party will have to resign itself to the fact that it has lost this battle.

  • vicki

    someone please remind them how wonderfully it worked out for consumers when banks were able to offer services across state lines and most of the banks wound up in states with the least regulations which hurt the consumers the most.

  • TR66

    “But crafting an alternative that can get 218 Republican votes — as few Democrats can be expected to back such a plan — is a tall order.”
    No, not just a “tall order” … try “impossible”. Thanks to the Tea Party, the GOP these days couldn’t agree on ordering a pizza. You really think Boehner can pull together 218 votes for an alternative health care plan? Not gonna happen. Not in their wildest dreams (or nightmares).

    • Joe WallStreet

      He couldn’t even get a significant number of his caucus to raise the debt ceiling and avoid defaulting.

  • Lou Alexander

    Makes me proud of the GOP. Four million people enrolled in the ACA, 40+ votes to repeal Obamacare and years and years later and the GOP is meeting to come up with an alternative.

    If we had moved at the same pace in the 19th century the slaves would have been freed around 1954…or maybe never.

  • Bob Viering

    If the Republicans can actually come up with something better than the ACA then it should be considered. But, they have had 5+ years and have come up with nothing of substance. Had they made themselves part of the process from the beginning everyone would be better off (well….except for Tea Partyites)

  • migtex1234

    LOL – they have zero backbone …Republicans have lost when they did not try
    to reach out to States & governors to cancel this horrible mess… and they folded on debt limit, then they will “continue” to “discuss immigration” = not one thing has our congress done for the citizens.

  • blfdjlj

    They won’t find 218 GOP votes for this… 30-40 Tea Party members will vote against anything that might be described as “government takeover of healthcare”.

    • migtex1234

      Everyone should forget LABELS and vote together to cancel ACA & ANY IMMIGRATION “REFORM”. Labels just hinder thinking for posters

  • Art Bagnall

    They are still trying to “put together” a health care bill? Five years after Obama was elected?

    What is stopping them besides the fact that Republicans don’t care about health care for the middle class and the poor?

    Alan Grayson was corrrect.

    The Republican health care plan is: “die quickly” and don’t expect any favors from the government you’ve been paying taxes to your entire life.

    And middle class suckers still vote Republican. Morons.

  • Mike

    What a bunch of maroons! Five years and 40+ failed votes to repeal and these nimrod Republicans still can’t come up with an alternative plan they can all agree on? Their incompetence is stunning. And these jokers want us to put them in charge?

  • disqusux

    It’ll only take them 5 minutes to agree on a policy; they always adopt the first stupid idea to come along.

  • dnaijaman

    It’s very simple:
    if republican comes up with an alternative ACA this year, it will moot their attack on OCare as their proposal will be subpar, covers less people and cost more. If they shelve any plan after boasting of producing one, that fact will moot their criticism of OCare as they will be rightly hammered for not coming up with their own alternative as they had promised.

    So what should they do? Simply advocating for the repeal of an imperfect law without their own alternative won’t work this time around as it did on 2010!


    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 as a truly bipartisan proposal.

    I have puts my thought down as succinctly as possible on a web site which I established free of any party affiliation or business alliance, but as a concerned
    individual, physician and American. The web site is a way for you to reference the plan in more detail and pass it on to your colleagues more easily. The website is Or you may 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”

  • Joe WallStreet

    The GOP proposal will probably be ready in 2016 and it’ll end up being ObamaCare Lite.

    • frellthat

      There’s never going to be a Republican proposal. They’ve had five years and (according to the article) haven’t even started gathering ideas yet. There just aren’t enough brain cells left in the Republican Party to have serious ideas anymore, or to even give the appearance of having serious ideas.

  • Layla

    Republican campaign promises are just as worthless as the Democrats.

  • Layla

    A lot of Members on both sides are not going to be in office much longer for the lies you have told the American people. We are going to be holding you to it this time.

  • Hutch King

    Yet another casualty in Hussein Obama’s personal jihad against medical care:

  • Jose Rodriguez

    I wonder how many people will have their identities stolen when the Obamacare website is hacked?

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