Capitol Hill

In 2010, Republicans campaigned on a pledge to repeal the health care law enacted by a Democratic Congress and widely considered to be President Obama's primary legislative accomplishment. On Jan. 19, the new Republican majority in the House followed through on its promise by passing H.R. 2, Repealing the Job-Killing Health Care Law Act, to fully repeal the law on a vote of 245-189.

NRCA opposed the health care law in 2010 and supports its repeal. A majority of NRCA members believe the law is fatally flawed because it fails to control rapidly rising health care costs and the numerous taxes, mandates and regulations it imposes on employers threaten economic growth.

On Feb. 2, the House vote to repeal the law failed to pass the Senate at 47-51. However, the repeal vote is only the beginning of the health care debate in the 112th Congress.

The strategy

House Republicans will pursue a two-pronged strategy beyond the repeal vote during the rest of 2011. Recognizing that full repeal of the health care law is extremely unlikely, the strategy will focus on laying the groundwork for major modifications.

First, House Republicans will hold numerous hearings to draw public attention to the law's most problematic components. In addition to reviewing how the law will affect the health care system, the hearings will allow for examination of the effects of the law's many regulations, mandates and taxes on economic growth and job creation.

House Republicans also will pursue smaller bills aimed at repealing individual components of the law. The first will be a bill to repeal the onerous Internal Revenue Service Form 1099 reporting provision authorized in the health care law. Although most bills that repeal individual components face an uphill battle in the Senate, some Democratic Senators may join Republicans in considering relatively modest changes to the law.

Additionally, House Republicans may attempt to withhold funding needed to implement various aspects of the health care law through the annual appropriations process—but that, too, is problematic given Democratic control of the Senate.

The second part of the Republicans' strategy is to develop their own plan to reform the U.S. health care system. In addition to passing H.R. 2, the House approved House Resolution 9 on Jan. 20, which instructs key committees to develop legislation addressing health care issues through private-sector reforms rather than government mandates. House Resolution 9 enumerates a dozen principles to which Republican health care legislation must adhere.

Beyond general principles, however, it remains unclear what legislative reforms Republicans will pursue. Initiatives they previously have proposed include tax credits to help people afford insurance; medical liability reforms; allowing competition among health care plans across state lines; and expanding "consumer-driven" reforms, such as health savings accounts. However, the alarming federal budget situation, as well as divergent interests among small and large businesses, may make it difficult for Republicans to move comprehensive reforms.

Although Republicans may be able to move alternative reforms through the House, it is unlikely major changes to the health care law will be enacted during the next two years. However, Republicans' efforts to move forward with their proposals likely will influence the health care debate that will take place during the 2012 presidential campaign.

The outcome

It is uncertain whether the health care law will be implemented in its basic format in 2014 or whether major modifications are possible before then. The law's future likely will be determined largely by the outcomes of the 2012 elections, as well as the outcomes of legal challenges in the courts.

If Republicans hold their House majority and/or capture control of the Senate—and, most important, if a Republican is elected president—there will be an opportunity to make major changes to the law in 2013.

Duane L. Musser is NRCA's vice president of government relations.