Republicans pledge healthcare repeal, promise reforms

On Wednesday, Jan. 5, 2011, the 112th Congress officially opened for business—and House representatives wasted no time. The changing of the leadership from former House Speaker Nancy Pelosi (D-Calif.) to current House Speaker John Boehner (R-Ohio), prompted Republicans to begin delivering on their campaign promises to repeal and replace healthcare reform, decrease spending, and increase transparency.

The first order of business was to establish House rules. These include publishing bills 72 hours before they are voted on, requiring all committees and subcommittees to webcast all hearings sessions, and cutting the House budget to save more than $35 million this year.

To fill a campaign pledge, House Republicans also introduced HR 2, the “Repealing the Job-Killing Health Care Law Act,” which is intended to revoke the Patient Protection and Affordable Care Act (PPACA).

The initial vote on HR 2, originally scheduled for Jan. 12, was postponed until Jan. 19, in response to the attempt on the life of Rep. Gabrielle Giffords (D-Ariz.) on Jan. 8.

The bill passed the House, but is unlikely to pass in the Senate and would surely receive a presidential veto. Nevertheless, a failed attempt at full repeal will not deter House Republicans from attempting to starve several provisions of PPACA by tightening the purse strings and cutting off funding.

Questioning constitutionality in the courts
Despite the House’s aggressive attempts to dismantle PPACA, analysts point out the bill’s fate may rest with another branch of government due to the concern over the constitutionality of the individual mandate.

Proponents of the mandate affirm that it is constitutional, citing that the economic implications (the costs passed onto taxpayers) resulting from an individual’s decision not to buy insurance are within the breadth of the Commerce Clause. Opponents of the provision counter that argument by stating that the Commerce Clause has no grounds to regulate inactivity or the decision not to buy something (ie, health insurance). Divergent verdicts on the matter in lower federal courts will most likely force the Supreme Court to make a final decision.

Future of the SGR
Although the focus on PPACA has pushed other healthcare issues to the side, a permanent fix to the physician payment formula under Medicare remains a hot issue. In fact, an amendment to the healthcare repeal bill requiring House committees to include a permanent fix to the flawed sustainable growth rate formula (SGR) in their healthcare reform legislation was the only Democratic amendment out of 31 to be accepted by House Republicans.

Whatever the fate of the repeal bill, the Republicans’ consent to a Democratic “doc-fix” amendment offers a glimmer of hope to physicians that a bipartisan solution to the SGR is possible.

A more substantive approach to Medicare reform may also gain steam this Congress if the new chair of the House Budget Committee, Rep. Paul Ryan (R-Wis.) has his way. In November 2010, Rep. Ryan and Alice Rivlin, a member of the National Commission on Fiscal Responsibility and Reform, proposed a Medicare voucher program. This “Ryan-Rivlin Plan” would give every Medicare-eligible American a subsidy payment to purchase private insurance beginning in 2011. The Congressional Budget Office has estimated that the plan would reduce federal budget deficits by $280 billion within 10 years of its implementation.

Change in Command
With Republicans in the majority, the leadership of all House committees shifts. The following reflects the newly elected chairs and ranking members of key House committees:

Appropriations
Chair: Harold Rogers (R-Ky.)
Ranking member: Norm Dicks (D-Wash.)

Energy and Commerce
Chair: Fred Upton (R-Mich.)
Ranking member: Henry A. Waxman (D-Calif.)

Ways and Means
Chair: Dave Camp (R-Mich.)
Ranking member: Sander M. Levin (D-Mich.)

Education and the Workforce
Chair: John Kline (R-Minn.)
Ranking member: George Miller (D-Calif.)

Judiciary
Chair: Lamar Smith (R-Texas)
Ranking member: John Conyers Jr. (D-Mich.)

Madeleine Lovette is the AAOS communications specialist in the office of government relations. She can be reached at lovette@aaos.org