The Washington Post

House Republican leaders craft their vision for an alternative to health-care law

House Majority Whip Kevin McCarthy (R-Calif.), seen here in October 2013, joined with Rep. Cathy McMorris Rodgers (R-Wash.) to form a 30-member working group to address the health-care law. (Carolyn Kaster/AP)

House Republican leaders are adopting an agreed-upon conservative approach to fixing the nation’s health-care system, in part to draw an election-year contrast with President Obama’s Affordable Care Act.

The plan includes an expansion of high-risk insurance pools, promotion of health savings accounts and inducements for small businesses to purchase coverage together.

The tenets of the plan — which could expand to include the ability to buy insurance across state lines, guaranteed renewability of policies and changes to medical-malpractice regulations — are ideas that various conservatives have for a long time backed as part of broader bills.

But this is the first time this year that House leaders will put their full force behind a single set of principles from those bills and present it as their vision. This month, House leaders will begin to share a memo with lawmakers outlining the plan, called “A Stronger Health Care System: The GOP Plan for Freedom, Flexibility, & Peace of Mind,” with suggestions on how Republicans should talk about it to their constituents.

“We’ve got to get to where you can compare the two perspectives, Republican and Democrat,” House Majority Whip Kevin McCarthy (R-Calif.) said in an interview. “We’ve got all of these bills out there, so we’re going to take this core of policies and grow from there.”

ACA enrollment numbers, state-by-state

Republicans have campaigned heavily on their opposition to the health-care law in this year’s congressional elections, betting that anger with the law will propel them to gain seats in the House and take control of the Senate. Those efforts accelerated last week after Republican David Jolly’s upset victory in a special House election in Florida in which the campaigns focused on the law.

In meetings with Speaker John A. Boehner (R-Ohio) last week, House leadership allies cast Florida as a sign of good things to come in November. But they also cautioned that Republicans needed to offer a clearer alternative.

“It’s going to be all about giving people a choice,” said Rep. Andy Harris (R-Md.), an anesthesiologist.

Democrats dismissed the Republican approach as a purely political gesture ahead of this year’s midterm elections, saying the focus on long-held conservative ideas was more of an attempt to rally Republicans than to find bipartisan solutions.

“If they had fixes, I’d certainly consider it,” Sen. Timothy M. Kaine (D-Va.) said. “But if they are trying to scrap it all, going back to the bad old days, it’s not going to go anywhere.”

A CNN-ORC International survey released Tuesday showed support for the Affordable Care Act ticking up slightly, with 39 percent of Americans saying they support the health-care law, an increase from 35 percent in December. Fifty-seven percent of those polled oppose the law, down from 62 percent in December.

The Republicans’ plan is hardly intended as a full replacement of the federal health-care law — and that is by design. They would prefer to see a shift away from the federal government and to the states, with an emphasis on getting more consumers on private plans.

As they finalize their alternative, House Republicans are continuing their years-long effort to take a legislative hammer to the law, passing a bill Friday that would delay the individual mandate and repeal Medicare’s sustainable-growth rate.

For the most part, House Democrats are not taking the bait. Outside the House chamber Thursday, Rep. Ron Barber (Ariz.), a Tucson area Democrat facing a difficult reelection race, said that he would like to “make some amendments and adjustments” to the health-care law but added that “the bill is the law and not going anywhere.”

At a news conference Thursday, House Minority Leader Nancy Pelosi (Calif.) said Democrats would not run away from the law and shrugged off talk that Florida could be a harbinger of looming Democratic losses in the House and Senate.

“I’m very proud of our House Democrats and how they have not only embraced the Affordable Care Act, because they helped create it, but how proud they are of it,” she said. “I think the Republicans are wasting their time using that as their electoral issue, and they will find that out.”

McCarthy, along with Rep. Cathy McMorris Rodgers (Wash.), the fourth-ranking Republican in the House, formed a 30-member working group, dubbed the House Obamacare Accountability Project, in May, vetting suggestions over long lunches and reporting back to House Majority Leader Eric Cantor (R-Va.). The group has met once every two weeks, usually in McCarthy’s spacious Capitol suite.

“The first priority was establishing trust, and then we moved forward,” McMorris Rodgers said. “We’ve touched every part of the philosophical range.”

The policies on the group’s radar have a conservative streak, and the academics and analysts consulted during early deliberations were largely drawn from conservative think tanks, with talks by James Capretta, a former official in the George W. Bush administration; Avik Roy, a writer for National Review; and Dennis Smith, a former adviser to Wisconsin Gov. Scott Walker (R).

Conservative leaders in the House, such as Rep. Tom Price (Ga.), a physician from the Atlanta suburbs, and Rep. Steve Scalise (La.), chairman of the Republican Study Committee, have also played critical roles. Their involvement has enabled the leadership to avoid complaints from the right flank — and ensured that Republicans would not veer from conservative doctrine.

But some conservatives are wary of the push to have House Republicans sing as a unified chorus. At Wednesday’s Weyrich Lunch on Capitol Hill, a gathering of hard-right operatives named after the late conservative strategist Paul Weyrich, there was much skepticism about the leadership’s strategy, with conservatives urging their allies to be cautious.

McMorris Rodgers, who gave the party’s official response to Obama’s State of the Union address in January, played down tensions, saying the early outline is a blend of four previous GOP bills: a replacement plan produced by the Republican Study Committee, a bill authored by Price, a Senate Republican proposal, and the House GOP’s 2009 alternative to the Affordable Care Act.

Next month, when the House breaks for its April recess, McMorris Rodgers will provide members with a PowerPoint presentation on the GOP plan and will later hold sessions to collect feedback on how the recommendations went over at town hall meetings. Publicizing stories of people who have seen premium increases is a priority.

“It’s not enough to say, ‘I told you so,’ ” McCarthy said. “The country has changed since Obamacare has come in — we understand that. But we’re going to offer specific ideas, making the big-picture case and on the micro level.”

A complete health-care overhaul remains the GOP’s overarching goal. GOP leaders, however, are open to adopting conservative versions of elements of the law. Regarding people with preexisting conditions, for instance, they point to the high-risk insurance pools, which would be managed and subsidized by states. On allowing children to stay on their parents’ health insurance plans until age 26, they said Republicans may back that policy.

Meanwhile, Senate Republicans are closely watching the House GOP’s activity. This year, Sens. Tom Coburn (Okla.), Orrin G. Hatch (Utah) and Richard Burr (N.C.) proposed their own alternative, which they suggested could be the basis for the party-wide pitch on health care.

“There are only so many answers — that’s the thing,” Coburn said. “I don’t care about the politics of it. I want to solve the problem. Eventually we’re going to have to roll up our sleeves and have some kind of combined message.”

Robert Costa is a national political reporter at The Washington Post.

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