What a GOP Senate Would Mean for Obamacare

Full repeal is impossible, but the GOP could do some real damage to the Affordable Care Act.

WASHINGTON, DC - OCTOBER 14: (L-R) U.S. Senate Minority Whip Sen. John Cornyn (R-TX), Senate Minority Leader Mitch McConnell (R-KY), and Sen. John Barrasso (R-WY) walk from McConnell's office to the Senate Chamber on October 14, 2013 in Washington, DC. As Democratic and Republican leaders negotiate an end to the shutdown and a way to raise the debt limit, the White House postponed a planned Monday afternoon meeting with Boehner and other Congressional leaders. The government shutdown is currently in its 14th day. 
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Sam Baker
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Sam Baker
June 23, 2014, 1:10 a.m.

A Re­pub­lic­an Sen­ate ma­jor­ity wouldn’t be able to fully re­peal Obama­care, but it could force some pretty sig­ni­fic­ant changes to the health care law.

For now, the GOP isn’t talk­ing much about what would come after Elec­tion Day. Its can­did­ates are fall­ing over them­selves to pledge their sup­port for full re­peal — which may well be a win­ning mes­sage in a cam­paign but will be polit­ic­ally im­possible even with the Sen­ate ma­jor­ity. After all, Pres­id­ent Obama will still be in the White House.

But as the odds of a GOP takeover in­crease, a rough out­line is start­ing to emerge of how Re­pub­lic­ans would handle Obama­care. Full re­peal might be a fantasy, but with total con­trol of Con­gress the GOP might be able to chalk up some real policy wins against the Af­ford­able Care Act, and the first tar­gets are already com­ing in­to view.

“The ul­ti­mate goal is to fully re­peal Obama­care and re­place it with com­mon­sense pro­pos­als that solve the cost prob­lem. But re­cog­niz­ing that Obama will be pres­id­ent for the next three years, we will use every lever we can in the mean­time to lay the ground­work for its re­peal,” a seni­or GOP aide said.

Win­ning the Sen­ate and keep­ing the House would also have some risks for the GOP. It would step up the pres­sure to pri­or­it­ize bills that Obama might sign, without dis­ap­point­ing con­ser­vat­ives who don’t want to see the party ac­cept Obama­care as the status quo. And it would bring in­to sharp­er re­lief the con­stant ques­tion of wheth­er Re­pub­lic­ans should ad­vance their own health care plans.

Here’s how a Re­pub­lic­an-con­trolled Sen­ate’s Obama­care strategy would likely play out:

First, ex­pect a vote on full re­peal. Re­pub­lic­ans will use any pro­ced­ur­al open­ing they can to get a full-re­peal bill to Obama’s desk, a Re­pub­lic­an health care staffer said. Yes, Obama will veto it, and there will be plenty of eye rolling about how many fu­tile re­peal votes con­gres­sion­al Re­pub­lic­ans have held. But the Sen­ate has nev­er held one, and any Re­pub­lic­an who doesn’t want to get primar­ied will want a chance to vote for re­peal be­fore mov­ing on to any­thing that might look like “fix­ing” Obama­care.

After that, Re­pub­lic­ans have two anti-Obama­care tracks — bills that might pass, and bills they could force Obama to veto.

There’s some low-hanging fruit that could gain bi­par­tis­an sup­port. If Re­pub­lic­ans win the Sen­ate, for ex­ample, Obama will al­most surely be presen­ted with a bill to re­peal the health care law’s tax on med­ic­al devices. That pro­pos­al has passed the House and could eas­ily pass the Sen­ate today, with strong bi­par­tis­an sup­port — if it ever came up for a bind­ing vote.

The GOP aide laid out a few more items that might win Demo­crat­ic sup­port, such as re­peal­ing the health in­sur­ance tax and step­ping up the pro­ced­ures for re­cap­tur­ing im­prop­er sub­sidies. Even a big-tick­et item like re­peal­ing the em­ploy­er man­date could at­tract red-state Demo­crats, al­low­ing Re­pub­lic­ans to ar­gue that they’re pur­su­ing bi­par­tis­an re­forms, even if most or all of their ef­forts are ul­ti­mately ve­toed.

Aides also said Re­pub­lic­ans will likely force Obama to veto a bill re­peal­ing the in­di­vidu­al man­date. There’s no way he’d ever sign such a bill, but the GOP sees polit­ic­al value in for­cing the is­sue all the way to his desk.

“It’s al­ways bet­ter to change the law than to force a veto, but on fun­da­ment­al dif­fer­ences, ve­toes can be use­ful too,” said Dean Clancy, a tea-party-aligned policy ana­lyst.

“Re­cog­niz­ing that Obama will be pres­id­ent for the next three years, we will use every lever we can in the mean­time to lay the ground­work for its re­peal.”

(Iron­ic­ally, it’s vul­ner­able Demo­crats who are prob­ably most eager to vote for some of these bills. Ma­jor­ity Lead­er Harry Re­id won’t call a vote on a device-tax re­peal; a Ma­jor­ity Lead­er Mitch Mc­Con­nell prob­ably would. And no one would be hap­pi­er about that vote than Sen. Joe Don­nelly, a Demo­crat from In­di­ana — a red state with a big device-in­dustry pres­ence.)

But even­tu­ally, the de­cisions for GOP lead­ers get harder: Do they want to fix­ate on un­pop­u­lar parts of Obama­care, es­sen­tially us­ing the Sen­ate ma­jor­ity to amp­li­fy the mes­sage the House has been send­ing for the past four years? Or would they be bet­ter off ad­van­cing their own ideas, send­ing Obama bills that lay out a con­ser­vat­ive vis­ion of health care policy, rather than simply chip­ping away at his vis­ion?

“If Re­pub­lic­ans think they’re go­ing to win big ma­jor­it­ies simply by say­ing the word ‘Obama­care’ over and over, I think they’re kid­ding them­selves,” Clancy said. “To be a gov­ern­ing ma­jor­ity, you have to act like a gov­ern­ing ma­jor­ity.”

But tak­ing on a sweep­ing pro­ject to over­haul the whole health care sys­tem has its own risks.

Everything in health care policy comes at a cost — lower premi­ums mean high­er de­duct­ibles, more doc­tors mean high­er premi­ums, cost con­trol means Medi­care cuts. Any plan is open to at­tack.

And Clancy, like oth­er con­ser­vat­ive act­iv­ists, would have the GOP take on some of the sac­red cows of health care policy — such as the law re­quir­ing emer­gency rooms to treat the un­in­sured and pa­tient-pri­vacy laws.

That’s cer­tainly an af­firm­at­ive vis­ion, but it’s one that would take the party a long way away from the re­l­at­ive safety of simply at­tack­ing Obama­care, and Obama­care is what’s un­pop­u­lar. People like the U.S. health care sys­tem over­all, and as Obama­care has shown, try­ing to change that sys­tem is an ex­tremely hard sell.

“There is something to” that con­cern, Clancy said.”It’s a fight against gov­ern­ment-run health care and man­dates, and not just about Obama­care, but right now they’re sty­mied in fight­ing Obama­care.”

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