Headache on horizon for GOP as it weighs health reform repeal

Passage of healthcare reform poses a dilemma for Republicans, with the party debating the merits of making its repeal a major campaign theme.

Lawmakers and strategists are determining the benefits of targeting President Barack Obama’s huge legislative achievement this November versus focusing more attention on what Democrats haven’t achieved — more jobs, lower unemployment and a significant improvement in the economy.

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Democrats have made the political calculus even more difficult by structuring the healthcare bill so the popular provisions begin immediately while significant tax impacts are delayed until 2013.

That hasn’t stopped GOP leaders, including Mitt Romney and Sen. Jim DeMint (S.C.), from strongly advocating for repeal as a major campaign theme.

“It raises taxes, slashes the more private side of Medicare, installs price controls and puts a new federal bureaucracy in charge of healthcare,” Romney, a potential 2012 presidential candidate, said of Obama’s healthcare reform in a statement.

But stressing healthcare could muddy the GOP message on jobs and the economy and put its candidates in danger of appearing callous or getting bogged down in intricate policy arguments.

“I don’t see it as a great argument for Republican campaigns this year,” said Joseph Antos, a healthcare scholar at the conservative-leaning American Enterprise Institute. “I don’t see healthcare as such as a big issue for them. I think it’s economy and jobs.”

Antos said Republican candidates would be in a tricky position because if they campaigned on a broad repeal of the Democratic healthcare reform law, it would open them up to political attack.
 If they chose to focus on overturning narrow provisions of the law, those arguments are “more technical and more complicated and not prone to the sound bite — they’re not really good on a campaign poster,” Antos said.

Republicans advocating repeal will be competing with popular provisions that start immediately, while having to warn against less attractive items that voters won’t feel for some time.

By August, the law will bar insurance companies from excluding children with pre-existing medical conditions and allow children to stay on their family policies until age 26.

This year, it will reduce the size of the Medicare drug benefit “doughnut hole” by $500, helping seniors whose prescription drug costs are not covered by the current program. It will also provide $5 billion in federal funding to create purchasing pools to help high-risk individuals buy insurance.

Taxes will go up by only $8.5 billion through 2012, the presidential election year, most of it to be borne by drug manufacturers and high-income earners.

It’s not until the year after the election that the $31.9 billion in tax increases go into effect, according to the Joint Committee on Taxation.

Beginning in 2010, the legislation would also provide tax credits to small businesses to give healthcare benefits to employees. Tax credits of up to 35 percent of premiums would be made available to companies immediately.

The only taxes that will kick in this year are a 10 percent excise tax on indoor tanning services and a fee on insurance companies, which are expected to earn less than $100 million for 2010.

“Even if Republicans scored a 1994-style landslide in November, how many votes could we muster to reopen the ‘doughnut hole’ and charge seniors more for prescription drugs?” wrote David Frum, who was a speechwriter for former President George W. Bush and has questioned the wisdom of Republicans campaigning on a repeal message. “How many votes to re-allow insurers to rescind policies when they discover a pre-existing condition? How many votes to banish 25-year-olds from their parents’ insurance coverage?”

 Frum noted in an essay published Sunday that even if Republicans captured the Senate and the House, they could not deliver on a promise to repeal healthcare reform because Obama would still occupy the White House and would veto the effort.

Frum is not alone.

“It’s risky to follow a repeal strategy because average Americans are going go find a number of things in the legislation they actually like; the crackdown on insurance companies will be very popular [and] closing the doughnut hole will be very popular,” said Darrell West, director of governance studies at the Brookings Institution.”

 “Democrats have shielded themselves from a tax backlash and developed legislation that will expand some benefits without immediately costing more for the average taxpayer,” he said.

Even so, some Republicans are charging ahead with a call to repeal healthcare reform.

Immediately after the House passed the Senate healthcare bill, DeMint announced a bill to repeal “Obama’s government takeover of healthcare.” DeMint’s Senate Conservatives Fund also called on GOP candidates to sign a pledge to support repeal of healthcare reform if elected to Congress.

Several candidates have already signaled they plan to campaign on repeal.

“Stand up and fight with me to repeal this bill and restore the American free enterprise system that has been the envy of the world for more than 200 years,” Rob Simmons, a GOP candidate for Senate in Connecticut, wrote in an e-mail to supporters.

The Democratic Senatorial Campaign Committee has already begun to target candidates who have shown support for repeal, such as Rep. Mark Kirk (R-Ill.), former New Hampshire Attorney General Kelly Ayotte and Kentucky Secretary of State Trey Grayson.

Whit Ayres, a Republican pollster, said jobs and the economy will be the No. 1 political issue in November. But he argued that healthcare reform could be an effective line of attack against Democrats.

“Repealing the onerous parts of the healthcare plan will be a very effective argument, especially the enormous fiscal burden we’re putting on our children,” Ayres said.

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Ayres noted that freezing scheduled cuts in Medicare payments to doctors, which Congress is expected to approve, would cost significantly more than the $140 billion in savings projected from healthcare reform projected over the next decade.

Mike Franc, vice president of government relations at the Heritage Foundation, said campaigning on healthcare reform would result in a broader debate on the role of government in society.

"Healthcare is going to be an all-purpose catchword that picks up broader concerns and values,” he said. “Repeal of the healthcare law will morph into repeal of Obama’s agenda.”