Months after healthcare repeal vote, GOP still working on 'replace'

More than four months after their triumphant vote to scrap the Democrats' healthcare reform law, House Republicans have yet to fulfill the second part of their campaign pledge to "repeal and replace" the legislation.

Republicans say healthcare has taken a back seat to issues like the debt ceiling and Medicare reform but stress that they have a number of reform proposals up their sleeve.

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"Our focus right now is on repealing all of ‘Obamacare’ and pieces of it where we can," said Rep. John Kline [R-Minn.], the chairman of the Education and Workforce Committee, one of three panels with jurisdiction over the health policy. "And then we're working on spurring the economy and getting America back to work with jobs.

“The replacement pieces for healthcare are still on the table,” Kline said, “but we're not pushing them right now because we've got a full plate with other stuff."

After the House's Jan. 19 vote to repeal the law, the GOP vowed to develop legislation that would limit the federal government's intrusion into the healthcare sector while preserving popular provisions such as the requirement that health plans cover everyone, regardless of pre-existing conditions.

"If we agree that this law needs improving," House Speaker John Boehner (R-Ohio) said at the time of the repeal vote, "why keep it on the books? Let's challenge ourselves to do better."

Since then, however, Republicans have focused on other issues that are only indirectly related to healthcare coverage, such as abortion and tort reform.

Democrats contend that Republicans simply have no better alternatives.

"We did a good job with the [healthcare reform] bill," said Rep. George Miller (D-Calif.), Kline's Democratic counterpart on the Education and Workforce panel. "It saves a ton of money, [and] it covers more people."

Republicans bristle at suggestions from Democrats that they have no ideas for reforming the healthcare system. They point to a number of hearings and mark ups as proof that they are hard at work on small-government solutions.

Polls suggest Republicans should be wary of dropping the ball on their replacement pledge.

While the healthcare reform law remains unpopular, a majority of Americans believe the status quo of rising premiums and uncertain coverage is unacceptable. 

A poll taken last month by the Kaiser Family Foundation found that Republicans favor replacing the healthcare law with conservative alternatives by a 47 to 28 percent margin.

Rep. Michael Burgess (R-Texas), founder of the Congressional Health Care Caucus, said part of the difficulty for his party is that the healthcare reform law is still in place.

"My difficulty now is that anything I introduce has to be against the background of established law," he said. "I have to do in against the background of going in and walking back parts of [the law] and instituting what I consider to be better policy in its place. It's a little more convoluted than if we could just repeal it and replace it."

In addition to the repeal vote, Republicans have managed this year — with the support of Democrats and the blessing of the White House — to end the 1099 tax reporting requirement that was included in the healthcare law. 

Additionally, medical malpractice legislation — which Republicans say is crucial for lowering healthcare costs — could come up for a vote on the House floor before Labor Day after sailing through two committees.

Another bill to allow insurance to be sold across state lines was the focus of an Energy and Commerce hearing last week.

Rep. Phil Roe (R-Tenn.), the chairman of the Education and Workforce health subcommittee, said the conservative Republican Study Committee is working on a half-dozen bills aimed at creating a "market-based approach to healthcare.”

The proposals include: medical malpractice reform; expanding health savings accounts that put consumers in charge of their healthcare spending; allowing health insurance to be sold across state lines; strengthening association health plans that are sold to individuals and small businesses; and promoting disease management programs.

"It will be a series of bills that will be looked at," Roe told The Hill. "Much of that legislation is already out there [but] we still have a couple pieces that we haven't worked out."

Burgess said he's working on legislation to provide the same coverage protections in the small group and individual markets as currently exist in the large-group market, as well as a bill to help states set up or expand their insurance pools for people with pre-existing conditions. He didn't know if either would get a vote, however.

Roe acknowledged that Republicans open themselves up to attack if they don't discuss and pass some of their ideas.

"We had 15, 20, 30 bills last year that never got heard," he said. "But these will get heard, and they'll get voted, and they'll get over to the Senate. Now, that's another issue, what happens in the Senate."