Washington Post:
With the House preparing to vote this week on whether to repeal the health care law, the chamber's new Republican majority already confronts a far more delicate task: forging its own path to expand health coverage and curb medical costs.
The House's GOP leaders have made clear that they regard the repeal vote, scheduled to begin Tuesday, as the prelude to a two-prong strategy that is likely to last throughout the year, or longer.
They intend to dismember the sprawling law, pushed through Congress by Democrats last year, by individual pieces before major aspects of it go into effect. At the same time, Republicans say, they will construct their own plans to revise the health care system, tailored along more conservative lines.
On the cusp of undertaking this work, the GOP has a cupboard of health care ideas, most going back a decade or more. They include tax credits to help Americans afford insurance, limiting awards in medical malpractice cases and unfettering consumers from rules that require them to buy insurance policies regulated by their states. In broad strokes, the approach favors the health care marketplace to government programs and rules.
House Republicans have termed their strategy "repeal and replace." But according to GOP House leaders, senior aides and conservative health policy specialists, Republicans have not yet distilled their thinking into a coherent plan.
"Replacing Obamacare is not something we can accomplish overnight," said the new House Energy and Commerce Committee chairman, Rep. Fred Upton (R-Mich.), using the GOP pejorative for the new law. "We want to get it right, and on complex issues like these with huge consequences for the economy and jobs and spending, that means it may take time. But mark my words, we will get this done."
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House committees plan to conduct hearings both to single out parts of the new law for criticism - starting within weeks with those pieces they say could harm jobs - and to develop their own proposals.
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Other elements of the GOP proposal would have been major departures from the new law. The plan would have let people buy insurance across state lines - a key plank of conservatives on health policy. The idea is to help drive down insurance prices by giving people access to less generous and less expensive insurance policies sold in states whose regulators require fewer medical benefits.
The Republican plan also would have expanded the use of "health savings accounts," another approach long favored by conservatives that lets people set aside money for future medical expenses on a tax-free basis, in combination with bare-bones insurance policies.
In addition, it would have restricted awards in successful medical malpractice lawsuits and would have given states financial help to devise market-oriented ways to expand coverage and lower the price of insurance.
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Part of a broader plan to reduce the deficit, Ryan's approach would diminish the nation's reliance on employers to provide health coverage by removing the tax preferences companies receive for insuring their workers. Instead, the government would give Americans tax credits to shop for insurance on their own. Ryan's plan also would redefine the nation's large public entitlement programs: Medicaid for the poor and Medicare for older Americans. Except for those now on Medicare or close to being eligible, the program would switch to giving people a "defined contribution" - that is, a federal payment toward their coverage - rather than the traditional "defined benefit," guaranteeing specific coverage no matter how much it costs.
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Ryan is one of the few people willing to deal with the long term problems in these entitlement programs and Democrats at best are willfully ignorant in even acknowledging the problem. Democrats seem to think they can squeeze providers and tax their way through the problem. This control freak approach would have a devastating effect on the health care business and on the patients.
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