Inside House Leadership’s 2014 Obamacare Strategy

Conservatives want a replacement bill, but GOP sources say Boehner’s looking for a small package of poll-tested health provisions for the election-year agenda.

US Speaker of the House John Boehner, Republican of Ohio, walks from the House chamber on June 28, 2012 on Capitol Hill in Washington, DC. Republican leaders set a July 11, 2012 vote in the House of Representatives to repeal US President Barack Obama's health care law, almost immediately after the Supreme Court upheld it. 'We don't have to accept 'Obamacare,'' said Boehner in a message sent on his Twitter account. 'The House will continue to fight for a full repeal.' 
National Journal
Tim Alberta
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Tim Alberta
Jan. 29, 2014, 3:15 p.m.

House Re­pub­lic­ans will try to co­alesce around a health care strategy when they huddle be­hind closed doors this week, but whatever emerges al­most cer­tainly won’t be the com­pre­hens­ive “al­tern­at­ive” to Obama­care that con­ser­vat­ives have long been agit­at­ing for.

Speak­er John Boehner said re­cently that mem­bers would de­vote sig­ni­fic­ant time to dis­cuss­ing health care at their an­nu­al con­fer­ence re­treat, and pre­dicted House Re­pub­lic­ans would “come for­ward with a plan to re­place Obama­care” upon re­turn­ing to Wash­ing­ton. But the speak­er’s words were met with skep­ti­cism by con­ser­vat­ive law­makers and aides, who have long feared Boehner’s team would snub a pair of sweep­ing Obama­care re­place­ment plans that have wide­spread sup­port in the House GOP.

Now, as Re­pub­lic­ans head to rur­al Mary­land for their three-day get­away, those fears are about to be real­ized.

Ac­cord­ing to mul­tiple law­makers and staffers fa­mil­i­ar with the situ­ation, House GOP lead­er­ship will not en­dorse either of the com­pre­hens­ive bills — one writ­ten by Rep. Tom Price of Geor­gia, and the oth­er craf­ted by Rep. Phil Roe of Ten­ness­ee and a work­ing group con­vened by Re­pub­lic­an Study Com­mit­tee Chair­man Steve Scal­ise. In­stead, Boehner’s team is ex­pec­ted to sur­vey the con­fer­ence in search of the most pop­u­lar and poll-tested in­di­vidu­al policies, as­semble them as a hodge­podge health care pack­age, and spend the elec­tion sea­son em­phas­iz­ing those spe­cif­ic ideas rather than push­ing a full sub­sti­tute.

This cau­tious ap­proach re­flects a fun­da­ment­al de­sire among top Re­pub­lic­ans to keep the fo­cus on the troubles that have sur­roun­ded Obama­care’s rol­lout and not dis­tract from the law’s short­com­ings by hawk­ing what would cer­tainly be a po­lar­iz­ing al­tern­at­ive. Just as im­port­ant, though, are the in­tern­al dy­nam­ics. Re­pub­lic­ans can’t count on Demo­crat­ic sup­port for a health care pack­age, so whatever they bring to the floor must have 217 GOP votes. And while both GOP meas­ures are pop­u­lar throughout the con­fer­ence, neither is a safe bet to win such sweep­ing sup­port.

“My sus­pi­cion is that that sup­port is not as broad as either my bill or the RSC bill,” Price, who meets reg­u­larly with lead­er­ship about health care strategy, re­cently told Na­tion­al Journ­al. He ad­ded: “We don’t get any help from the oth­er side. So the ques­tion is: Where is the sweet spot for our con­fer­ence to be able to rally around the com­mon themes and com­mon de­nom­in­at­ors for health care?”

In con­ver­sa­tions with Price and oth­er Re­pub­lic­ans, sev­er­al policy pro­pos­als emerged as the like­li­est to garner near-un­an­im­ous sup­port in the House GOP. These ideas are noth­ing new: Pur­chas­ing health in­sur­ance across state lines, ex­pand­ing ac­cess to Health Sav­ings Ac­counts, and lim­it­ing the scope of med­ic­al mal­prac­tice law­suits are pop­u­lar, poll-tested health care policies that con­ser­vat­ives have long ad­voc­ated.

These pro­pos­als, and per­haps oth­ers, could be neatly pack­aged and pro­moted as the House GOP’s tar­geted set of health care solu­tions. Law­makers could re­but Pres­id­ent Obama’s as­ser­tion that they lack ideas of their own by pro­mot­ing re­l­at­ively safe, in­of­fens­ive policies that don’t dis­tract from Obama­care. It’s the pre­ferred route for Re­pub­lic­ans who fear that put­ting forth a com­plex health care al­tern­at­ive — es­pe­cially one that cov­ers far few­er Amer­ic­ans than does Obama­care — could dam­age the GOP’s chances of win­ning back the Sen­ate in Novem­ber.

“The best way to achieve con­ser­vat­ive policy goals is to hold the House and take over the Sen­ate,” one House lead­er­ship aide said.

But House con­ser­vat­ives may not be sat­is­fied with such a small-ball ap­proach. Some have spent months, if not years, craft­ing com­pre­hens­ive solu­tions and lob­by­ing lead­er­ship to strike a bold con­trast against Obama­care. In their view, 2014 presents an ideal op­por­tun­ity to do so.

“I say the elec­tion year is the per­fect time to do it. We run in two-year cycles. There’s al­ways go­ing to be some ex­cuse not to do something,” said Scal­ise, who has prom­ised to push the RSC plan this week­end. “We didn’t run for Con­gress — I sure didn’t run for Con­gress — to sit back and be afraid of get­ting in­volved in the de­bate. I’m ex­cited about the things we stand for. I want to put them on pa­per. And I want to have votes on the House floor so people have to pick a side.”

A trio of Re­pub­lic­an sen­at­ors this week in­tro­duced their al­tern­at­ive to Obama­care, a plan pre­dic­ated on con­sumers shoul­der­ing a high­er share of their health care costs. Of course, House Re­pub­lic­ans un­der­stand that whatever solu­tion they co­alesce around in Cam­bridge, Md. — if any at all — will take on great­er na­tion­al defin­i­tion be­cause of their abil­ity to put le­gis­la­tion on the floor for a de­fin­ing, elec­tion-year vote.

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