GOP plans to replace health-care overhaul if it controls Congress, but with what is unclear

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By Ricardo Alonso-Zaldivar
Monday, September 20, 2010; 12:22 AM

Republicans are promising to repeal and replace President Obama's health-care overhaul if they win control of Congress. But with what?

Not even they know.

Some have proposed changes to workplace coverage, even turning Medicare into a voucher plan. Many prefer small steps that tiptoe around political land mines. Others want a clean start.

"During the health-care debate, there was just as much division within Republicans as there was between the parties," said Douglas Holtz-Eakin, an adviser to Sen. John McCain (R-Ariz.) in his 2008 presidential bid. "It will be more visible now that Republicans may be in charge of one house, because those divisions will come to the surface."

At least 75 House seats are competitive in this election, the majority held by Democrats, a recent Associated Press analysis said. The GOP only has to win 40.

One of the first acts of a Republican majority would be a vote to repeal what they dismiss as "Obamacare." But they haven't said much about what would replace it.

A GOP bill rejected by the Democratic-led House last year is the closest thing to a starting point. That plan would cover an additional 3 million people by 2019, compared with nearly 33 million under the Obama health-care law. It would lower premiums modestly for many small businesses and for people buying insurance directly. It wouldn't solve the nation's long-term cost and coverage problems.

"On a scale of 1 to 1,000, it's about a 5," scoffs former Senate majority leader Tom Daschle, a senior Democratic adviser.

Yet some Republican proposals are as far-reaching as anything Democrats have tried. A budget crisis could push them to the forefront because lowering health costs is critical to reducing record federal deficits.

Many of those ideas come from Rep. Paul Ryan (R-Wis.), one of a group of younger lawmakers trying to energize the party leadership. Along with Sen. Tom Coburn (R-Okla.), Ryan sponsored legislation that would replace Medicaid with private insurance for most low-income people. The idea is to foster personal responsibility on the theory that consumers will seek better value for their health-care dollars.

The plan would make employer coverage taxable to employees, but that would be offset with a tax credit available to all. It could be used to buy coverage individually or to keep a plan at work. Some people with generous employer coverage could face higher taxes.

In contrast to the Democrats' health-care law, there would be no federal mandate that individuals get coverage or employers help pay for it.

The plan, however, is a hard sell. Any attempt to tamper with the tax-free status of employer health care is certain to provoke an all-out counterattack from labor unions. That hasn't deterred Ryan. He also risks antagonizing the senior citizens' lobby.

On his own, Ryan has proposed to convert Medicare into a voucher system. People who become eligible starting in 2021 would get a federal payment to buy private insurance. Because of the timing, most baby boomers get to keep the government-run program.

"Repealing Obamacare is a step in the right direction," Ryan said. "It's not enough. You have to reform health care itself."

Repeal is not a surefire proposition. Even if the Senate goes along, Obama could veto it, and Republicans probably won't have enough votes to override. But they have a backup plan: Use the congressional power of the purse to deny the administration funds to carry out the law.

- Associated Press


© 2010 The Washington Post Company

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