CQ Roll Call - Conservative House Republicans Poised to Unveil Their Health Care Replacement Bill

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By Melissa Attias

Republicans are focused on repealing the president's signature health care law. But a group of lawmakers on the Republican Study Committee in the House wants it known that their party has ideas to replace the law, too, and they are working to finalize legislation that assembles those proposals in a package.

The group, led by Tennessee Republican Phil Roe, began crafting its measure in late spring and plans to finish up the final language when lawmakers return to the Capitol in September. Roe said in an interview this week that about 80 percent of the bill is currently in legislative language totaling roughly 180 pages, but the bill may be closer to 250 pages once tax provisions are added.

Details of the proposal come as congressional Democrats and President Barack Obama have continued to chide Republicans for lacking an alternative to the health care law (PL 111-148, PL 111-152). At a news conference last week, Obama said Republicans used to say they have a replacement but he no longer hears about it "because basically they don't have an agenda to provide health insurance to people at affordable rates."

And on Wednesday, former House Speaker Newt Gingrich at the Republican National Committee summer meeting told his fellow Republicans they haven't put forth a plan of their own. "I will bet you, for most of you, you go home in the next two weeks when your members of Congress are home, and you look them in the eye and you say, "What is your positive replacement for Obamacare?' They will have zero answer," Gingrich said, according to CNN.

Roe said the RSC wanted to have a product to show that Republicans do have ideas to lower health care costs and expand coverage, although he also acknowledged that there might not be enough time left in the House schedule this year for action on the RSC plan. The RSC is made up of more than 170 House conservatives, some of whom Republican leadership has struggled to bring on board for votes this Congress, which means a proposal its members support could gain traction. But it will need the backing of House leaders to advance.

The group's bill would pull from legislation that Republicans have agreed on in the past, many aspects of which were included in the Republican substitute during debate on the 2010 overhaul, and make them part of a larger package. No budget estimates have been calculated yet.

"Every time our membership goes home, all you hear is that Republicans don't have any ideas," Roe said. "Well, that's the reason I came to Congress. We had a lot of ideas about what to do about it. Unfortunately, nobody listened to any of them."

Tennessee Republican Marsha Blackburn, who is part of the group putting together the RSC proposal, also emphasized that her party has been working on replace concepts for years. She expects Republicans to advance some replace measures as time permits, in addition to their oversight of the rollout of the 2010 law.

"We'll be bringing them forward," said Blackburn, the vice chairwoman of the Energy and Commerce Committee, in an interview before the August recess. "You'll see us work on this in September when we come back."

House measures that have been introduced to replace all or portions of the health care law include bills by Blackburn (HR 762) and Georgia Republicans Tom Price (HR 2300) and Paul Broun (HR 2900).

Instructions From the Top

Roe said the RSC proposal was set in motion when Chairman Steve Scalise, R-La., asked him to lead a group to put together a replace plan. Along with him, Scalise and Blackburn, Roe said the other RSC members involved were Price, John Fleming of Louisiana, Paul Gosar of Arizona,Todd Rokita of Indiana, Renee Ellmers of North Carolina and Rick Crawford of Arkansas.

Scalise also set parameters for the proposal, Roe said, including that it repeal the 2010 law; lack mandates, tax increases and subsidies; equalize tax treatment between individuals and businesses; and address pre-existing conditions. Roe said the group did not attempt to tackle Medicare or Medicaid and that the main idea was to expand health coverage and lower costs.

While Roe noted that the bill will include language designed to equalize the tax treatment of businesses and individuals when it comes to health insurance, he declined to provide additional details because that section is still being worked on. An aide said that "our goal is to reform the tax code in such a way that an individual will get the same tax benefits whether he/she receives insurance from an employer or purchases it on his/her own."

Provisions may be amended as the proposal moves forward. But as it currently stands, Roe said the bill would:

* Repeal the 2010 health care law, expand Health Savings Accounts and raise their maximum contribution, and increase the deduction to encourage wellness programs aimed at providing incentives for healthy behavior.

* Use association health plans to allow small businesses to pool with other small businesses to obtain insurance and alter a requirement related to COBRA coverage for individuals with pre-existing conditions.

* Put $25 billion over 10 years toward state-run high-risk pools designed to help people with pre-existing conditions purchase affordable insurance. "I think there's a suspicion of government-funded high-risk pools, but the fact that you let the state administer these and run them I think will take some of the angst out of it," Roe said in response to a question about whether he's had difficulty getting the current GOP caucus to line up behind the party's previous ideas, like high-risk pools. Many current Republican lawmakers were not in Congress during the debate on the health care law and the GOP alternative.

* Permit individuals to purchase health insurance across state lines, rather than be restricted to their state of residence.

* Bar data from comparative effectiveness research from being used to deny coverage.

* Overhaul the medical liability system, with provisions that echo past legislation introduced by Georgia Republican Phil Gingrey.

* Prohibit taxpayer funding for abortion, with exceptions for the life of the mother, rape and incest.

Not Looking for "Perfect'

Although Roe noted that he personally would have gone further with some provisions to expand coverage, he said the proposal was designed to meet the parameters laid out by Scalise. The working group has almost unanimous consensus in these areas, he added, and they spent a lot of time going over the proposal.

"You will never have a perfect product," Roe said.

Roe said he presented the proposal to the RSC members the Wednesday before Congress left for the August recess and that the measure has been shopped around to groups such as the Chamber of Commerce, the Heritage Foundation, the National Federation of Independent Business, Heritage Action for America and Club for Growth. So far he has only heard positive feedback, Roe said.

Before the measure is introduced, Roe plans to hold listening sessions to get RSC members up to speed on all of the details and will have a PowerPoint presentation ready. Roe said he has not yet spoken with House leadership about the proposal because the RSC wanted to inform its own members first.

"We need a majority buy-in of the RSC members before we move this forward," Roe said.

Still, the co-chairman of the GOP Doctors Caucus and chairman of the Education and the Workforce subcommittee with jurisdiction over health acknowledged that the effort will face some challenges. For one thing, Roe said, Republicans want to keep the focus on criticism of the health care law rather than criticism of the RSC proposal.

"There's a bit of a negative side of bringing out your own plan because you'll change the subject," he said.

Congress also has a full agenda and not many days in session to get it accomplished. Lawmakers have to deal with funding the government before Oct. 1, the debt ceiling and immigration, Roe said.

"I just don't know whether there's enough time, legislative days, between now and the end of the year to get this in there," Roe said. "I would like to think it would, but just realistically with all that's on the plate, I don't see how there's enough time, legislative days, to do much."

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