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Republicans plan to stress private-sector alternatives to the president's plan

By Shailagh Murray and Perry Bacon Jr.
Washington Post Staff Writer
Wednesday, February 24, 2010; A04

Republicans are preparing to use Thursday's White House health-care summit to sell their own ideas for using the private marketplace to expand coverage and reduce costs, but they remain wary of fumbling away what they believe is an advantage on the issue heading into this year's critical midterm elections.

GOP leaders are acutely aware of the stakes involved in the extraordinary bipartisan gathering. An effective performance could give their party a vital image boost as November approaches. But if the party's delegation stumbles or oversteps, President Obama and congressional Democrats could see the session provide new life to the stalled health-care legislation they have been laboring over for a year.

The Republican summit strategy is twofold: to portray the Obama plan as radical and ruinously expensive, while reassuring a potential television audience of millions that the GOP takes the health-care crisis seriously and is prepared to address it headon.

But Republicans are not prepared to match every Democratic provision with one of their own. "You will not see from us a 2,700-page comprehensive rewrite of one-sixth of our economy," said Senate Minority Leader Mitch McConnell (Ky.). "We don't think that ought to be done."

Their goal is to present voters with a clear choice between a Democratic approach that seeks to expand the government role in health care, and the Republican aim of finding solutions in the private marketplace. "There'll be no question as to where Republicans stand," said House Minority Whip Rep. Eric Cantor (Va.). "It is with a much more common-sense, modest approach to health-care reform."

The roster of GOP lawmakers set to attend the session remained unclear as of late Tuesday, but as many as 19 Republican Senate and House lawmakers are expected to be on hand Thursday. Senior Republican aides said the delegation would seek to portray the Obama health-care bill as a further threat to the record deficit and target specific parts of the Democratic proposal, including tax increases and Medicare cuts. Republicans also will be prepared to argue that Congress should be focused on the more urgent need for job creation rather than health-care reform.

GOP aides said they anticipate that Obama will zero in on potential weaknesses in the Republican plan. For instance, the House Republican bill would not ban insurance companies from denying coverage to people with preexisting conditions. Nor it would it restrict how much insurance companies can raise their rates.

"We're fully aware of the president's skills," said one top GOP congressional aide. "But this is a debate we've been winning for the last eight months."

As Democratic proposals began to take shape last spring, Republicans were holding their own internal discussions about how to approach the health-care debate. Some wanted to offer a path to universal health care centered on conservative, market-based ideas, while others favored more targeted, incremental legislation to correct fundamental flaws in the system. Others embraced a strategy that focused solely on attacking ideas put forth by Democrats.

The raucous town hall meetings of the August congressional recess, driven largely by opposition to widespread health-care reform proposals, ended that debate. The three GOP senators who had been negotiating with Senate Democrats backed away from the table, and GOP leaders shelved the idea of offering a broad alternative overhaul proposal.

Instead, Republicans rallied behind a set of long-held conservative ideas, many proposed by President George W. Bush but never enacted. The list included new rules that would allow people to buy insurance policies across state lines, the expanded use of health savings accounts, funding to encourage state-based coverage innovation, and limits on lawsuits against doctors.

The Congressional Budget Office estimates the House GOP approach would cost $61 billion over the next 10 years, compared with nearly $1 trillion for various Democratic plans. The Republican proposals would cover about 3 million uninsured people, whereas the Democratic legislation aims to reach 30 million. The House rejected the GOP proposal on a 258 to 176 vote Nov. 7, before narrowly approving the Democratic bill.

One challenge for Republicans at the summit will be to convince people that they are taking on the system's major problems, just in a different way. Instead of expressly banning insurance companies from denying people coverage, the Republican plan would give more money to high-risk pools that operate in most states and cover people who cannot get insurance companies to sell them plans.

Another of the core Republican ideas, allowing individuals to buy health insurance across state lines, also has proved controversial among health-care experts. The idea would be to allow people who live in states with heavy insurance regulation to shop for policies in states with fewer rules. The CBO estimates this idea would save money for people who are healthy, but might increase costs for people who are older or already have illnesses.

Democrats proposed fewer border restrictions in their plan, but each state would effectively create minimum benefit standards.

Republicans do back some ideas also supported by Democrats, including allowing young adults to stay on their parents' plans and providing incentives to small businesses to provide coverage to employees. But more broadly, Republicans want to move the health-care system to an individual-based model, allowing people to shop for their own care.

Democrats, by contrast, are more focused on working through the existing employer-based system, although Obama's plan would create a individual insurance market for people who don't have access to coverage at work.

One Republican attendee at the summit will be Sen. John McCain (Ariz.), who is not a prominent voice in the congressional health-care debate but who offered an ambitious health-care plan as the 2008 GOP presidential nominee. McCain's plan envisioned a broad shift away from employer coverage to individual coverage, spurred by ending the tax exemption for employer-provided health benefits. Obama strongly opposed ending the exemption.

GOP lawmakers think Thursday's summit will support their belief that a more gradual approach than the one most Democrats are embracing will win favor with the public.

"We don't need a big comprehensive bill that turns 17 percent of the economy upside down and cuts Medicare and raises premiums and raises taxes and transfers big cost to states," said Sen. Lamar Alexander (R-Tenn.). "We need to set reducing health-care costs as our goal and move step by step toward that goal to re-earn the trust of the American people."

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