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GOP Majority Has 'Menu of Options' for Attacking Health Law

By Melissa Attias, CQ Roll Call

January 6, 2014 -- Republicans plan to use their House and Senate majorities to take targeted swipes at the health care overhaul, cognizant that full repeal is out of reach as long as President Barack Obama is in the White House.

Many of the expected attacks will be familiar to House members, who took up numerous bills to repeal or tweak provisions after Republicans won control of the chamber in the 112th and 113th Congresses. But for the first time since the enactment of the 2010 law, the Senate is also in Republican hands, increasing the odds that some measures may land on Obama's desk.

"We won't have a chance realistically to repeal the law until January of 2017 at the very first if everything would go our way," says Pennsylvania Republican Joe Pitts, chairman of the House Energy and Commerce Health Subcommittee. "What we're going to have to do is take a piecemeal approach."

That doesn't mean a vote on full repeal is off the table. Newly elected members who ran on the issue as well as returning conservatives will be anxious to go on the record showing they want to scrap the entire law, and GOP leaders have little to lose by obliging them. Some would also like Republicans to use the budget reconciliation process to advance a repeal measure, though that is less certain.

But taking action on individual provisions could be seen as fixing the law by the most conservative lawmakers, prompting resistance. While most targeted health care bills received solid GOP support in the past, Pitts's 2013 legislation to move money from the law's prevention fund to shore up high-risk insurance pools for individuals with preexisting conditions had to be pulled from the House floor when necessary support didn't materialize.

First up on the piecemeal agenda could be legislation to change the law's definition of a full-time employee from one who works 30 hours a week to 40 hours. The benchmark is used to determine whether employers have to provide their workers with health coverage or face penalties. Republicans say the current threshold incentivizes businesses to cut their employees' hours below the 30-hour mark, because the mandate applies to employers with 50 or more full-time workers.

In a Wall Street Journal op-ed the day after the midterm elections, Speaker John A. Boehner, R-Ohio, and incoming Senate Majority Leader Mitch McConnell, R-Ky., said an early priority is legislation to "restore the traditional 40-hour definition of full-time employment, removing an arbitrary and destructive government barrier to more hours and better pay created by the Affordable Care Act of 2010."

The House voted on stand-alone legislation in April to move the threshold to 40 hours, drawing support from 18 Democrats. But the Democrats who oppose the change cite its cost and say that more workers will be at risk of having their hours cut if 40 hours becomes the new standard.

Another target often cited by McConnell is the law's 2.3 percent excise tax on medical devices, which opponents say squelches innovation and costs jobs. Like changing the 30-hour definition, the tax would cost money to repeal, has some bipartisan opposition and has already been voted on in the House. Seventy-nine senators also voted in favor of repealing it as part of a nonbinding vote on a fiscal 2014 budget resolution.

Other targeted strikes could be directed at a Medicare cost-cutting board that has yet to be appointed; the mandate that employers cover their workers; the requirement that most individuals obtain coverage or pay a penalty; an annual tax on health insurance companies; and a provision in the law designed to limit insurers' financial losses, known as the "risk corridor" program, which critics have labeled a bailout. Most have been the subject of past House votes.

Less certain is whether Republicans decide it's beneficial to advance legislation to replace the law as long as repeal is impossible. On the one hand, some think the exercise is important because it could demonstrate what the party stands for. But there's concern that moving a replacement plan without a repeal simply opens the GOP to attacks from the left.

"I don't see any real advantage, to be honest with you, because all we do is create reasons why the other side says it won't work," says Rep. John Fleming of Louisiana, incoming co-chairman of the GOP Doctors Caucus. "I think the best thing to do is to hold it, ready to go when that moment in history comes."

Pitts says he foresees Republicans introducing a "menu of options" in the new Congress that allows lawmakers to go on the record about their preferences. "Some members might have a little heartburn about one thing or another—a menu of options gives them a little bit more flexibility," he says.

None of the replace plans the GOP has introduced has advanced, though incoming Ways and Means Chairman Paul D. Ryan is working on a new one. According to a spokesman, the Wisconsin Republican has spoken to Sen. Marco Rubio, R-Fla., and others, and conversations about how to proceed are ongoing.

Meanwhile, a Supreme Court challenge to the law's subsidies that help some residents in 37 states buy coverage could prompt a shift in the overall GOP strategy. If justices side with plaintiffs arguing that the law doesn't allow subsidies in states using the federal exchange, Republicans may have to decide whether to step in with legislation or allow individuals to lose the financial help.

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