Washington Bureau -
JANET HOOK
Reporting from Washington After months of criticizing Democratic proposals to revamp the healthcare system from the sidelines, Republicans are moving aggressively to present an alternative approach and undercut critics' portrayal of the GOP as the "Party of No."
Defining a stark contrast with the Democrats' comprehensive effort to provide near-universal health insurance and force other major changes, Republican leaders this week began spotlighting their own incremental approach with a different goal: controlling health care costs.
They are proposing to do so through market-oriented measures that would limit medical malpractice lawsuits, expand the use of tax-sheltered medical savings accounts, let people shop for insurance outside their own states, and make it easier for small businesses and hard-to-insure people to get coverage ideas that reflect conservatives' suspicion of sweeping new programs, federal spending and additional regulation.
The GOP plan is not meant to match the Democrats' in size and scope: It is, by design, a less costly bill with more modest ambitions. The cost of the package, yet to be precisely determined, will surely be far less than the Democrats bill, which would exceed $1 trillion over ten years.
But those savings come at a cost in terms of impact: It includes no subsidies or other guarantees that coverage will be affordable to people of modest means. "What we've learned over many, many years is that the reason people don't have insurance is that they can't afford it," said Drew Altman, president of the Henry J. Kaiser Family Foundation, an nonpartisan health-policy research group. "You can't make much progress toward helping the uninsured unless you help them buy it." The Republicans' proposals have long been on their wish-list but were not enacted even when the party controlled Congress and the White House. They are being resurrected at a time when some Republicans warn that they are in danger of being seen as guardians of an unpopular status quo in health care.
"Come campaign time, voters need to know what health care reforms Republicans have supported," said Whit Ayres, a Republican pollster.
House Democratic leaders Wednesday laid the groundwork for a Saturday vote on their massive health care legislation, after settling on a compromise they believe can diffuse a long-simmering debate in their own ranks over how to restrict federal funding for abortion.
The proposal does not differ substantially from a provision originally in the healthcare bill that requires insurance companies that provide federally subsidized plans to require consumers to pay for any abortion benefit with their own money. But senior Democrats hope that by tightening that restriction further they can satisfy enough socially conservative Democrats to get a majority.
Republicans, who harbor no hoping of passing their alternative during Saturday's scheduled debate, have spent months criticizing Democrats' plan as an intrusive, expensive government program an argument with strong appeal for the party's conservative base.
Rep. Bob Inglis (R-S.C.) said that, in his solidly conservative district where he faces a primary challenge from the right in his 2010 reelection bid, he has staged all of his health care speeches back home in front of signs that read "16 Reasons to Oppose Obamacare."
But this week, House Republican Leader John Boehner (R-Ohio) shifted the emphasis by unveiling the Republican alternative and launched a campaign to raise his party's public profile on the issue. "This is an intentional strategic shift toward not being just the opposition party, but trying to be the alternative party," said David Winston, a Republican pollster close to the congressional leadership.
House Republicans have yet to say how much their alternative would cost. It surely would cost less than the Democrats' bill, estimated at more than $1 trillion over ten years--but also would do far less to reduce the ranks of the uninsured.
The Republican bill conspicuously lacks major elements of the Democratic bill: There is no expansion of Medicaid, no requirement that individuals buy insurance, no penalties for employers that do not offer insurance, no subsidies to help the needy pay premiums.
The GOP plan did include some more modest Democratic provisions. It too would make it easier for young adults to remain on their parents' health policies. It would end the controversial insurance practices of imposing annual or lifetime limits on benefits, and of cancelling coverage after a policyholder becomes sick.
But the GOP does not include one of the most popular elements of the Democrats plan a ban on insurance companies' denying coverage to individuals with pre-existing medical conditions even though Republican leaders for months have cited that as a bipartisan goal.
And, rather than give more power and money to the federal government to address those problems, Republicans take a conservative approach by looking to states, market forces and individuals. Their bill would provide aid to states to form "high risk" insurance pools that would cover people including those with pre-existing conditions who cannot get coverage through their jobs or in the individual market. The GOP bill also would provide incentive grants for states that reduce premiums and the ranks of the uninsured. Small businesses would be encouraged but not required to cover their employees, under provisions that would make it easier to band together to get group rates.
To curb costs through increased competition, the GOP plan would make it easier for insurance companies to sell policies across state lines. And it would impose new curbs on medical malpractice lawsuits on the theory that health care inflation is fueled by defensive medicine and the rising cost of malpractice insurance.
To increase incentives for individuals to control their own health spending, the bill would expand the use of tax-favored health savings accounts. And it would allow employers to provide steeper discounts in insurance premiums to employees who adopt healthy lifestyles.
Noam N. Levey contributed to this report.
Reporting from Washington After months of criticizing Democratic proposals to revamp the healthcare system from the sidelines, Republicans are moving aggressively to present an alternative approach and undercut critics' portrayal of the GOP as the "Party of No."
Defining a stark contrast with the Democrats' comprehensive effort to provide near-universal health insurance and force other major changes, Republican leaders this week began spotlighting their own incremental approach with a different goal: controlling health care costs.
They are proposing to do so through market-oriented measures that would limit medical malpractice lawsuits, expand the use of tax-sheltered medical savings accounts, let people shop for insurance outside their own states, and make it easier for small businesses and hard-to-insure people to get coverage ideas that reflect conservatives' suspicion of sweeping new programs, federal spending and additional regulation.
The GOP plan is not meant to match the Democrats' in size and scope: It is, by design, a less costly bill with more modest ambitions. The cost of the package, yet to be precisely determined, will surely be far less than the Democrats bill, which would exceed $1 trillion over ten years.
But those savings come at a cost in terms of impact: It includes no subsidies or other guarantees that coverage will be affordable to people of modest means. "What we've learned over many, many years is that the reason people don't have insurance is that they can't afford it," said Drew Altman, president of the Henry J. Kaiser Family Foundation, an nonpartisan health-policy research group. "You can't make much progress toward helping the uninsured unless you help them buy it." The Republicans' proposals have long been on their wish-list but were not enacted even when the party controlled Congress and the White House. They are being resurrected at a time when some Republicans warn that they are in danger of being seen as guardians of an unpopular status quo in health care.
"Come campaign time, voters need to know what health care reforms Republicans have supported," said Whit Ayres, a Republican pollster.
House Democratic leaders Wednesday laid the groundwork for a Saturday vote on their massive health care legislation, after settling on a compromise they believe can diffuse a long-simmering debate in their own ranks over how to restrict federal funding for abortion.
The proposal does not differ substantially from a provision originally in the healthcare bill that requires insurance companies that provide federally subsidized plans to require consumers to pay for any abortion benefit with their own money. But senior Democrats hope that by tightening that restriction further they can satisfy enough socially conservative Democrats to get a majority.
Republicans, who harbor no hoping of passing their alternative during Saturday's scheduled debate, have spent months criticizing Democrats' plan as an intrusive, expensive government program an argument with strong appeal for the party's conservative base.
Rep. Bob Inglis (R-S.C.) said that, in his solidly conservative district where he faces a primary challenge from the right in his 2010 reelection bid, he has staged all of his health care speeches back home in front of signs that read "16 Reasons to Oppose Obamacare."
But this week, House Republican Leader John Boehner (R-Ohio) shifted the emphasis by unveiling the Republican alternative and launched a campaign to raise his party's public profile on the issue. "This is an intentional strategic shift toward not being just the opposition party, but trying to be the alternative party," said David Winston, a Republican pollster close to the congressional leadership.
House Republicans have yet to say how much their alternative would cost. It surely would cost less than the Democrats' bill, estimated at more than $1 trillion over ten years--but also would do far less to reduce the ranks of the uninsured.
The Republican bill conspicuously lacks major elements of the Democratic bill: There is no expansion of Medicaid, no requirement that individuals buy insurance, no penalties for employers that do not offer insurance, no subsidies to help the needy pay premiums.
The GOP plan did include some more modest Democratic provisions. It too would make it easier for young adults to remain on their parents' health policies. It would end the controversial insurance practices of imposing annual or lifetime limits on benefits, and of cancelling coverage after a policyholder becomes sick.
But the GOP does not include one of the most popular elements of the Democrats plan a ban on insurance companies' denying coverage to individuals with pre-existing medical conditions even though Republican leaders for months have cited that as a bipartisan goal.
And, rather than give more power and money to the federal government to address those problems, Republicans take a conservative approach by looking to states, market forces and individuals. Their bill would provide aid to states to form "high risk" insurance pools that would cover people including those with pre-existing conditions who cannot get coverage through their jobs or in the individual market. The GOP bill also would provide incentive grants for states that reduce premiums and the ranks of the uninsured. Small businesses would be encouraged but not required to cover their employees, under provisions that would make it easier to band together to get group rates.
To curb costs through increased competition, the GOP plan would make it easier for insurance companies to sell policies across state lines. And it would impose new curbs on medical malpractice lawsuits on the theory that health care inflation is fueled by defensive medicine and the rising cost of malpractice insurance.
To increase incentives for individuals to control their own health spending, the bill would expand the use of tax-favored health savings accounts. And it would allow employers to provide steeper discounts in insurance premiums to employees who adopt healthy lifestyles.
Noam N. Levey contributed to this report.
