Putting the brakes on ObamaCare

If Republicans take control of one or both houses of Congress this fall, many will have been elected with a promise to “repeal and replace” ObamaCare. But what are their options, really? There likely will be an initial showdown, but President Obama will surely veto any challenge to the law, and it would be hard to imagine mustering the votes to overturn it.

Information is the key weapon. Republicans can use congressional hearings to explain what ObamaCare is doing to the economy and the health sector. Their strongest cases would be built around jobs, the cost of health care, and the rising deficit.

If evidence shows that looming mandates on employers are crippling job-creation, they should be repealed. If health costs are rising, as they inevitably will be, Congress needs to hold hearings to investigate the causes and explain why the offending taxes and regulations must be repealed.

Here are six key strategies that a Republican Congress could employ to put on the brakes:

• Defund it. House Republican Leader John Boehner of Ohio has vowed to choke off funding for implementation of the legislation, starting with parts that are especially egregious such as the “army of new IRS agents” needed to police compliance.
While Republicans could target the most damaging provisions of the legislation and tie their defunding measures to appropriations legislation that the president wants and needs to sign, they'd better be ready for battles. When former House Speaker Newt Gingrich lost a stand-down with President Clinton over closing down the government in 1996, it was widely seen as a setback for GOP efforts to scale back big government.

• Dismantle it. To focus committee action and floor votes, Republicans can look for provisions in the law that Democrats are on record as opposing. For example, Senate Budget Committee Chairman Kent Conrad (D., N.D.) has said that the new federal program to fund long-term care-the Community Living Assistance Services and Supports Act, or CLASS Act-is "a Ponzi scheme of the first order, the kind of thing that Bernie Madoff would have been proud of." Mr. Conrad and five of his Democratic colleagues sent a letter to Senate Majority Leader Harry Reid (D., Nev.) before the legislation passed opposing the program and expressing "grave concerns" about its fiscal sustainability.

Other highly unpopular provisions include the requirement that all businesses must file 1099 forms with the IRS to report any purchases totaling more than $600 in a year. This is designed to raise about $17 billion over 10 years from tax cheats. Rep. Dan Lungren (R., Calif.) was the first to introduce legislation to repeal this gigantic paperwork burden. Many Democrats in vulnerable districts who voted for the health law are also anxious to repeal this provision, which the National Federation of Independent Business says will impact 40 million businesses.

• Delay it. Republicans can also vote to postpone cuts to the popular Medicare Advantage program, postpone mandates requiring that individuals and businesses purchase and provide health insurance, and delay imposition of the $500 billion in taxes required by the law. Mr. Obama wouldn't likely sign such legislation, but the debate would shine a light on problems that haven't received nearly enough attention.

• Disapprove regulations. The Congressional Review Act of 1996 (CRA) gives Congress the authority to overturn regulations issued by federal agencies if both houses approve, with a two-thirds majority needed to override a presidential veto. This would be difficult to pull off. But proposing a resolution of disapproval under the CRA gives Republicans a platform to express strong disagreement and bring attention to especially egregious rules.

The current congressional majority wants to gut the CRA, and the House passed a bill that would eliminate the requirement that federal agencies submit their rules to Congress before they can take effect. The Senate has not yet acted, but this measure should be on the Republicans' watch list for the rest of the year.

• Direct oversight and investigation. Other aspects of ObamaCare are ripe for public hearings. For example, rules dictating how much insurance companies must spend on direct medical benefits are already hugely controversial-even before they have been issued. Businesses are also aghast at the narrow openings they have to protect their current health plans from onerous federal regulation. Republicans could summon many witnesses to testify about the impact of this regulatory straightjacket.

Congress also must keep a careful eye on the evolving cost estimates and deficits. Former Congressional Budget Office Director Douglas Holtz-Eakin estimates that the cost of the subsidies for private insurance could rise to $1.4 trillion -triple the $450 billion assumed by the current CBO. This is because the legislation creates strong incentives for businesses to drop coverage and dump their employees into federally subsidized insurance. Congress has a responsibility to protect taxpayers from what surely will be exploding costs.

Republicans also will want to call Donald Berwick, head of the powerful Centers for Medicare and Medicaid Services, to testify before Congress and detail his regulatory agenda for implementing the health-care law. He escaped that duty earlier this year when the White House avoided his Senate confirmation by giving him a controversial recess appointment.

• Delegate to the states. Congress should encourage states to press forward with their own innovative programs. For example, Gov. Mitch Daniels's popular and fiscally responsible Healthy Indiana Plan expands coverage to the uninsured using a health savings account model. And the lightly regulated Utah Health Exchange provides a marketplace for individuals and small businesses to purchase affordable, portable health insurance. Both are threatened by ObamaCare.

The more that states are marching forward with reform that suits the needs and pocketbooks of their citizens, the easier it will be for Congress to repeal ObamaCare and start over.
Americans intuitively understand that government can't pay for huge new entitlement programs and the expansion of Medicaid with imagined cuts to Medicare, while still improving Medicare's long-term solvency. They also know that job creation is flat and that employers' fear of ever-rising health benefit costs is part of the problem. They need to hear the evidence that their fears are valid.

The real wallop of ObamaCare will come in 2014, when most of the spending begins and businesses and individuals are hit with intrusive and expensive mandates. The main job of Republicans, should they capture Congress, will be to slow down implementation of the law and explain to the American people the damage it will do-and already is doing-to our economy. If the White House changes hands in 2012, they can be ready to start with a clean slate and begin a step-by-step approach to sensible reform.

Access more healthcare commentary by Grace-Marie Turner at the Galen Institute.