Will Health Care Overhaul Survive Republican Control of the House?

Nov. 3, 2010— -- Since the health care bill passed in March, Republicans have vowed to "repeal and replace" it as a central part of their "Pledge to America."

Now that they will assume control of the House of Representatives next year, that GOP mission is among the options they'll have to weigh, health policy analysts say. "Repeal and replace" is unlikely to happen, the analysts agreed, so Republicans may have tough choices ahead.

"Absent a supermajority in both houses of Congress, efforts by either or both houses to reverse the law will most surely be vetoed," said Jay Wolfson, distinguished service professor of public health and medicine at the University of South Florida in Tampa.

Gail Wilensky, an economist and senior fellow at Project HOPE, an international health foundation, said, "The real question is whether the Republican House and the more closely divided by Democratic Senate work to fix aspects that are regarded as particularly troublesome or leave it as is, so that the more egregious parts are more obvious."

Either way, she added, Congress must address at least one issue immediately.

"They need to fix the Medicare physician fee schedule right away," she said. "Starting on Dec. 1, Medicare payments to physicians will drop 23 percent." The cuts are part of a congressional plan to help reduce the budget deficit.

Ken Thorpe, professor of health policy at Emory University in Atlanta, said, "They can do a 13-month extension of that and give Congress time to think how to ... [fix the payment system], but it will cost billions to freeze the payment system."

Revisions to Bill Tricky to Navigate

If the Republicans choose to revise the bill, the challenge will be to preserve the more popular provisions while eliminating the ones that are not.

"The bill is so interwoven that it's hard to pull things out and keep things you like because it's all interrelated," Thorpe said.

Thorpe said some of the health care bill's provisions that resonated well with the public, such as the elimination of pre-existing conditions as a reason to deny insurance coverage and guaranteed availability of coverage, won't be able to remain in effect unless there's a mandate requiring coverage for all.

"You need more people buying in to fund not excluding previous conditions," said Dr. David Nash, dean of the Jefferson School of Population Health at Thomas Jefferson University in Philadelphia.

Mandatory coverage is likely to make taxes increase, Nash said, which will be unpopular.

With a repeal unlikely, Congress could debate whether to pay for certain provisions in the bill, although analysts disagreed on how much power it has over the payment system.

"It is within the power of Congress to appropriate funds, and to the extent to which Congress can choose not to fund certain initiatives could affect the implementation of those components of the law that require funding," professor Wolfson said.

Jefferson's Nash said, "The way the payment system is set up, it's almost automatic. It will take a wholesale repeal to stop this payment system."

Instead of a repeal, opponents could also try to stall the bill's implementation.

"They could delay things using hearings or by opposing various appointments and other bits and pieces of the bill," Nash said.

In a news conference, President Obama said he is willing to discuss Republicans' ideas for cutting health care costs or other changes to the current bill. He also acknowledged that the provision requiring employers to complete a 1099 form whenever they spend at least $600 on goods and services could be problematic for some businesses.

But he stressed that some of the bill's provisions aren't up for debate, such as helping seniors get prescription drugs or denying insurance to people with pre-existing conditions.

"I don't think you'd have a strong vote from people saying, `Those are provisions I want to eliminate."'

Congress Needs to Focus on Cost-Cutting, Analysts Say

In addition to the challenge of improving access to care, analysts say another challenge Republicans will face in their efforts to repeal or change the bill is to incorporate more ways to cut skyrocketing health care costs by focusing on improving health care delivery.

"One of the biggest weaknesses of the current bill is that it really didn't go far enough to really reform how chronically ill patients are treated and how chronic diseases are prevented," Emory's Thorpe said. "There isn't enough focus on cost-containment."

Alan Sager, professor of health policy and management at the Boston University School of Public Health, said, "The government ignores most important health care issues; training more family doctors and paying them adequately, stabilizing all needed hospitals, cutting ER wait times, and working to contain costs."

Despite their predictions, analysts say, there are many questions remaining.

"It's all a matter of what these guys retain from the current bill," Thorpe said.