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Conservative Goals Could Stymie Some GOP Health Care Law Efforts

Conservative groups and some lawmakers are pushing Republicans to focus on legislation that would ruin the health care law’s implementation — a strategy that complicates efforts to pass any other kind of health care bill.

Some conservatives balked earlier this month at voting on a bill from the GOP leadership that would have extended part of the law, and now the House will instead vote Thursday on fully repealing the law.

Speaker John A. Boehner, R-Ohio, said the 70 new House Republicans had asked for a chance to cast their votes on the law (PL 111-148, PL 111-152). But the vote also serves to reassure conservative groups that Republicans are focused on dismantling the overhaul they call Obamacare.

Dan Holler, communications director for Heritage Action for America, said his group supports voting on full repeal but also wants Republicans to focus on bills that would damage the law’s implementation.

“We’re sort of weary of anything that takes the focus away from halting the implementation,” he said.

“You cannot allow the Medicaid expansion to go forward. You cannot allow the exchanges to go forward, because people get brought into the system and they expect a certain benefit from the government,” he added. “And once that happens, it is very hard to take it away.”

Republicans should concentrate, Holler said, on legislation that strikes at the heart of the law rather than bills that would strike individual, unpopular provisions but allow the main part of the law to go forward.

“It’s one thing to go after IPAB, which is obviously a very popular target for good reason, but that doesn’t necessarily stop Obamacare from going into law,” he said, referring to the law’s Independent Payment Advisory Board, which is tasked with constraining Medicare spending growth.

Andy Roth, vice president for government affairs at Club for Growth, agreed, saying he expects “something big” on the law to happen now that some Democrats are raising concerns about its implementation.

“The club obviously supports full repeal,” Roth said. “There are various partial repeals that we would support, like getting rid of the Medicaid expansion, getting rid of the exchange subsidies, the individual mandate.”

Rep. Matt Salmon, R-Ariz., has introduced legislation to repeal the law’s funding for state Medicaid expansion (HR 1404) and to eliminate the subsidies for consumers buying insurance in the law’s health exchanges (HR 1908), but neither has seen committee action yet.

Sen. Orrin G. Hatch, R-Utah, said Republicans can’t be expected to fix the law by getting rid of the unworkable provisions and helping its implementation. He said he expects the law’s costs to “explode” next year if Congress doesn’t stop substantial parts of it.

“I don’t have a lot of confidence in any kind of repair work on this; it’s just that bad,” he said. “I really don’t think you can really repair it.” Hatch has introduced bills to repeal the law’s individual mandate (S 40) and the requirement that employers provide health insurance to employees (S 399).

This ethos leaves the future unclear for other Republican health care bills that would repeal less central parts of the law or merely make changes to it. Both Heritage Action and Club for Growth opposed the GOP leadership bill (HR 1549) that would have extended enrollment in the law’s high-risk insurance pools by transferring money away from its Prevention and Public Health Fund.

The groups said that amounted to fixing a problem with the law rather than tearing it down, and some conservative Republican members agreed. The bill may still come back to the House floor this month, but Holler said his group would not support it in its original form.

Bills that repeal individual provisions of the law may also have a more difficult time getting passed, especially if conservatives view them as removing the worst parts of the overhaul to leave a stronger overall product.

Despite bipartisan support in the House and Senate to repeal the law’s medical-device tax, the way forward on a bill to do that remains unclear.

One possible vehicle for repealing the tax would be in a comprehensive tax overhaul package. House Ways and Means spokeswoman Michelle N. Dimarob noted in an email that “everything is on the table, and the chairman has said he will absolutely repeal the Medical Device Tax in tax reform.”

That could be easier than moving the tax repeal bills (HR 523, S 232) as stand-alone pieces of the legislation. The other obstacle in passing individual repeal bills is that Republicans tend to offset their cost by taking money from other parts of the law — thus losing Democratic support.

Melissa Attias contributed to this report.

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