WASHINGTON -- The troubled start of the Affordable Care Act is giving Republican critics in Congress a new game plan.
Rep. Renee Ellmers, R-N.C., says it’s no longer all about votes to repeal, but about taking advantage of the current turmoil to demand delays and fixes and to offer an alternative.
Republicans in the House of Representatives have voted more than 40 times to repeal Obamacare, with Ellmers on board each time. But those bills went nowhere in the Senate. Republican demands to defund the law triggered the 16-day government shutdown. But since the shaky beginning of the online insurance website, “We’re in a different position,” Ellmers said.
“We have this factual, verifiable data that’s showing that those who had a health care plan that they liked can’t keep it,” she said in an interview this week about what’s ahead for the opposition to President Barack Obama’s signature domestic law.
Voter anger has put pressure on Democrats, who, in turn, have made their anxieties known to the White House. Next year is a re-election year for the entire House. In the Senate, 21 Democratic seats will be contested.
With political concerns mounting, the president on Thursday agreed to let insurance companies continue to offer existing individual plans for one year, even if they don’t meet the health law’s standards.
Ellmers, a nurse from Dunn and whose district includes parts of Wake County, called it “a political maneuver to buy time.” She said she would “work tirelessly to repeal and replace this terrible law.”
She’s been a frequent Republican critic of Obama’s signature domestic accomplishment on national and local television. But last summer, she took a more low-profile role as one of eight members of the conservative Republican Study Committee who drafted their own version of a health insurance overhaul over the summer.
She said it was a response to legitimate criticism that Republicans wanted to get rid of Obamacare, but had never offered an alternative.
“I think there are things in the Affordable Care Act that are very appealing to the American people,” she said. “I think the American people want to see everyone having affordable health care. I agree with that. Now, mandating it? That’s a different issue. People need choice and they need to have the ability to say ‘no.’”
Rep. Phil Roe, R-Tenn., a physician who led the effort to develop a counter to Obamacare, said his goals were no new taxes, no subsidies and no mandates, but more access to affordable care. Ellmers was one of the first allies he sought and she put in the time, he said.
In less than four months, the group had a 180-page proposal, Roe said. Among its elements:
– Repeal Obamacare.
– Pump $25 billion over 10 years into state high-risk pools to help people with pre-existing conditions buy insurance.
– Allow consumers to deduct the cost of health insurance from their taxes, something only employers now can do.
– Deny the use of federal funds for abortion.
The GOP plan envisions that the costs will be borne by savings – nothing from Treasury – largely as a result of the medical liability changes, according to Rep. Steve Scalise, R-La., chairman of the GOP study committee.
Ellmers said expanding the high-risk pools and other provisions would be enough to make health insurance affordable for people with pre-existing conditions, but acknowledged that it wouldn’t help them all.
Jonathan Oberlander, a health policy expert at the University of North Carolina at Chapel Hill, said the plan Ellmers helped draft isn’t a viable replacement for Obamacare.
“It would not work,” he said. “It would leave most uninsured Americans uninsured.”
He said that interstate insurance purchases aren’t feasible and high-risk pools have been tried before and aren’t a substitute for the insurance protections under the Affordable Care Act for people with pre-existing conditions.
“It doesn’t represent new thinking as much as a continuing GOP commitment to maintaining most of the status quo in U.S. health care and embracing only incremental reform,” he said in an email.
Oberlander said that any health-reform law must define a minimum standard of coverage.
“Americans with substandard coverage are only one illness from finding out they don’t have adequate insurance, and that is a problem we have to address,” he said.
Adam Linker, a health policy analyst with North Carolina Justice, a consumer advocacy group, also said he didn’t think the alternative plan was serious.
North Carolina’s high risk pools had lifetime caps. When people hit them, they had to pay for their own health care again. The Affordable Care Act eliminated caps and put everyone in the same risk pool.
Linker said that the plan that Ellmers worked on would result in two systems: private insurance that includes young, healthy people and a high-risk pool for others that requires billions of dollars poured in.
“It’s not a viable way to finance your health care system,” he said.
Barney Keller, a spokesman for the Club for Growth, a group that advocates smaller government and lower taxes, said he liked some of the main provisions in the Republicans’ Obamacare alternative. Still, the group wants to see Ellmers defeated next year by a more conservative Republican. The Club for Growth looks at voting records only and among her votes it objects to is one she cast in 2011 to raise the debt limit.
But David Wasserman of the nonpartisan Cook Political Report, who watches House races, said the past fades in people’s minds, and Ellmers’ anti-Obamacare activism helps her politically.
“It will insulate her from her only political threat,” he said, “which is a primary challenger from the right.”
House Republicans on Friday are scheduled to vote on a bill by Rep. Fred Upton, R-Mich., that would allow people to keep their health insurance plans for a year. Ellmers said she would support it.
Obama’s plan would require insurers to tell people what parts of their plans were substandard compared to the Affordable Care Act. In the Senate, Sen. Mary Landrieu, D-La., has a similar proposal that would also require insurance companies to point out where their old plans were different from the new law’s requirements. Sen. Kay Hagan, D-N.C., is a supporter.
Ellmers said she likes to see that interest from Democrats.
“It makes me hopeful we can come together on a replacement,” she said.