Republicans say they'll repeal and replace President Barack Obama's health care law, but tinker and tweak is as far as they're likely to get.
And that might not be a bad thing if you're a GOP strategist. It keeps the issue Senate Republican leader Mitch McConnell calls the "tipping point" in the midterm elections alive for 2012, when they'll try to unseat Obama himself.
Republicans will control the House in January, but they don't have the votes to overcome a Senate filibuster, much less Obama's veto on repeal. Plan B, denying funds to carry out the law, could backfire if it escalates to a government shutdown.
Other options call for legislative guerrilla tactics.
Republicans could use the oversight authority of Congress to slow down or block regulations, essentially tying up the instruction manual for the overhaul. Expect flyspeck scrutiny of agencies implementing the law.
GOP lawmakers may be able to pick off unpopular provisions. Obama has already said he's willing to "tweak" an IRS reporting requirement that small businesses find burdensome. Another target is a yet-to-be-named board with the power to make Medicare cuts. And look for a move to tighten restrictions on abortion coverage.
Aides said Wednesday no decision has been made on the first bill that Republicans will take up in the new Congress, and party leaders put taxes and government spending ahead of health care repeal as priorities. The GOP's repeal strategy is fluid.
"This is not a 'Jeopardy!' question where there is just one right answer," said Rep. Joe Barton, R-Texas, a leader on health care. "House Republicans are committed to repealing the existing Obamacare bill. That's not window dressing, but we are going to do a three-pronged approach. We'll do repeal, we'll do a reform bill, we'll do a defunding bill. It's all of the above."
The repeal slogan energized big-government foes in the midterm elections, helping turn out Republican voters. However, trying to deliver on it could stir up a backlash. Exit polls on Election Day found voters divided. Forty-eight percent said they supported repealing the overhaul, but 47 percent said it should be expanded or kept as it is.
During a news conference Wednesday, Obama pretty much dared Republicans to follow through on their threat. Citing popular provisions of the law, such as help for seniors with high prescription costs and guaranteed coverage for people with medical problems, the president said, "I don't think you'd have a strong vote for people saying ... 'Those are provisions I want to eliminate.'"
Mindful that some of the new benefits are popular, House Republican leader John Boehner has stressed that a "replace" measure preserving some aspects of Obama's overhaul would go with legislation to repeal it. But not all his followers agree. Some conservatives want a straight vote on repeal that would leave the "replace" part for later.
And then there's the wild card: federal budget politics.
If Obama and the Republicans can strike a grand bargain to reduce government deficits, it could open a path for GOP ideas such as curbs on malpractice lawsuits. Subsidies for the uninsured could be slowed or pared back, since the big coverage expansion under the law doesn't start until 2014.
"It will be far easier to scale back an entitlement nobody has received than a program that people are already on," said economist Douglas Holtz-Eakin, who served as a top policy adviser for 2008 GOP presidential candidate John McCain.
The last Republican to run the federal Health and Human Services Department isn't forecasting repeal.
"I think it either fails in the Senate or is vetoed by the president," said former HHS Secretary Mike Leavitt. "Ultimately, there will be some kind of a budget summit or bipartisan attempt to break the logjam, and many of the provisions of health reform will be put on the table at that time, and there will be changes."
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