Repeal Isn't Only Way to Block Health Law, Says House GOP

Susan Jaffe

July 11, 2012

July 11, 2012 (Washington, DC) — As expected, the Republican-controlled US House of Representatives voted today 244 to 185, mostly along party lines, to repeal the Affordable Care Act (ACA) — for the 31st time. And once again, President Barack Obama promised to veto the legislation repealing his landmark health law should it reach his desk, which is unlikely, given the Democrat-controlled Senate. However, Republicans have several other strategies available to delay or block implementation of the law.

Congress has already eliminated some individual provisions, including trimming subsidies for purchasing health insurance and cutting funds for the law's Prevention and Public Health Fund. So far, Congress has struck $52 billion from the law, Debbee Keller, a spokesperson for the House Committee on Ways and Means, told Medscape Medical News in a written statement.

Whether additional cuts will gain bipartisan support remains to be seen, but Republicans will keep trying.

"House Republicans will keep repealing bits and bits of the law, step by step," said a House Republican staffer, who declined to speak on the record. "This is what the American people want."

However, during today's debate on the repeal bill, Rep. Steny Hoyer, the Democratic Whip from Maryland, mentioned last week's opinion poll by the independent Kaiser Family Foundation that found a majority of Americans want Republicans to stop blocking the law and focus on other national issues.

"It's time for Republicans to end their relentless obsession with taking away healthcare benefits from millions of Americans," said Hoyer. "It's a waste of time."

Rep. Michael Burgess, MD, a Texas Republican who chairs the Congressional Health Care Caucus, told Medscape Medical News that the budget cuts required under the sequestration process later this year offer another opportunity to cut money for implementation. He acknowledged that in doing so, other government functions could be jeopardized. "You certainly may need to do so to show you're serious about putting restrictions on that funding."

There is also a new role for states to stall implementation of the ACA.

"The Supreme Court's decision provides states with a few more tools to block a portion of the law's mandates," said Keller. In its June 28 ruling, the court invalidated a provision that would have required states to expand Medicaid, a state-federal health insurance program for low-income families, or else risk losing all federal Medicaid funding. Some 17 million Americans were expected to gain coverage under the expansion in 2014, but so far 7 states have said they will not participate.

There may be other tools available to impede the law, but the best one will come in the November presidential election, Burgess told Medscape Medical News. "A straight line is the shortest distance between 2 points, and that straight line right now is Mitt Romney's election — that solves a multitude of problems."

Romney has pledged to repeal the law, but that would first require both houses of Congress to approve repeal legislation.

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