"The only alternative that Obamacare's critics have is, well, 'let's just go back to the status quo,'" said President Obama recently, "because they sure haven't presented an alternative."
It's an argument Democrats make all the time -- often, these days, to divert attention from the ongoing problems of their troubled national health care scheme. But still, why haven't Republicans presented an alternative to Obamacare?
GOP leaders would protest immediately: They have come up with dozens of health care bills, only to see them rejected by Democrats. But the fact is, Republicans have not united behind a single health care proposal, even as millions of Americans would like to see what they've got. Why?
For one thing, they don't believe in the Obamacare approach. At the time of the Affordable Care Act's debate and passage, about 85 percent of Americans had health coverage. Given that, conservatives simply would not create a sprawling, comprehensive, intrusive, bureaucratic, loaded-with-unintended-consequences plan to achieve an (incomplete) semblance of universal coverage.
So they won't ever have their own version of Obamacare. Rather, they favor targeted attempts to solve specific problems. Like fixing the tax inequities between people who receive coverage through their jobs and those who buy it on the individual market. Setting up mechanisms through which people with pre-existing conditions can purchase coverage. Allowing the purchase of insurance across state lines. Doing something about outsized medical malpractice awards.
Mention those proposals to Democrats, and they'll scoff. They're the same-old, same-old GOP hobbyhorses that will leave millions of Americans without health insurance.
But the fact is, the health care debate has changed. It has been changed by the millions who have had their health coverage canceled and who face higher premiums, higher deductibles, narrower doctor networks, diminished choices of prescription drugs and other burdens. The situation is so serious that Obamacare might actually create more uninsured by January 2014.
That is precisely the opposite of the stated intent of the Affordable Care Act. And it changes the political argument. When Democrats mock Republican plans to fix specific health care problems as too limited, Republicans can now cite the millions of Americans facing new burdens under the Democratic scheme. Why not try something different, and less damaging?
Of course Obama will never give up Obamacare. But the public might, if Republicans have something better.
Now, many House Republicans have gotten behind a plan. The American Health Care Reform Act, H.R. 3121, includes many of the GOP's standard health care prescriptions. It starts by repealing Obamacare, then includes a tax fairness provision, state lines provision, high-risk-pool provision, malpractice provision, and others.
It's not the perfect bill. Conservative writer Ramesh Ponnuru questions some of its tax provisions and its malpractice plan, but still concludes, "Even with these flaws, though, the Republican plan is superior to Obamacare."
The bill is the work of the House Republican Study Committee, led by Rep. Steve Scalise, R-La. It has 116 co-sponsors, which is an important number because it is more than half the Republican caucus in the GOP-controlled House.
"We're at a majority of the majority who support the bill," says one well-connected Hill aide. "We've had a number of members of the Republican Study Committee who have expressed to House leadership a desire to vote on an Obamacare alternative."
But so far the House GOP leadership has been uninterested in going forward with that alternative. Leadership sources say their focus is on Obamacare, and the hope of forcing some Democrats to abandon the law. Others point to shortcomings with H.R. 3121's funding provisions. Still others say uniting behind a bill would just give Democrats a new target. And others argue no proposal is capable of attracting the 217 GOP votes needed for House passage.
The fact is, top House Republicans don't seem to be pushing very hard to build support for a GOP alternative. But it is time to move. Obamacare has weakened Democrats, weakened the president, weakened the idea of a comprehensive national health care plan. And that is an opportunity for Republicans.
"What Obamacare has done for the Republican Party is that Americans really want to hear what they have to say about health care," says one GOP strategist.
The bill's authors have asked Obama for a meeting to discuss health care. They can forget about that. But they are still going forward. A powerful committee chairman, Rep. Fred Upton of the Energy and Commerce Committee, has asked the Congressional Budget Office to score the bill, which will yield an estimate of its budgetary effects. And they will continue to gather sponsors.
It might turn out Republicans will finally produce their long-awaited alternative -- whether leadership wants it or not.