Republicans have pledged to “repeal and replace” President Barack Obama’s health-care overhaul. If the U.S. Supreme Court strikes down the law, they may struggle to deliver on the second part of their vow.
A plurality of Americans, 43 percent, say they want to retain the 2010 law with only small modifications, while 15 percent say the measure should be left alone, a Bloomberg National Poll shows. One-third say it should be repealed.
The court will rule in the next week on the constitutionality of the law, the centerpiece of which is the mandate that most Americans buy insurance or pay a fine.
A rejection of all or part of the Affordable Care Act would be a setback for Obama, undercutting his biggest legislative victory. It would also present a challenge to Republicans. With elections approaching, House Republicans are signaling they have no immediate replacement to offer.
“If you’re out to get more votes in six months, coming forward with a detailed program is not the optimal strategy,” said Henry Aaron, a health-policy scholar at the Brookings Institution in Washington. Republicans have little to gain in proposing a comprehensive plan since it may draw criticism from health-care providers or consumers, he said.
U.S. House Speaker John Boehner, an Ohio Republican, said on June 19 the House would take a “step-by-step approach” to revamping health care.
A number of the law’s features are popular. Laetitia Adam, a 33-year-old independent voter from Miami, said she supports the insurance mandate as well as the provision allowing children up to age 26 to stay on their parents’ health plans.
“For the most part, I agree with the law as it is,” Adam, a respondent to the June 15-18 poll, said in a follow-up interview. “You can’t afford to get sick without insurance,” said the graphic artist. The law just “needs to be made more simple.”
In a nod to public support for aspects of the law, insurers UnitedHealth Group Inc., Aetna Inc. and Humana Inc. said this month they would retain some benefits even if the court strikes down the law, including allowing young adults to stay on their parents’ plans and offering free preventive care.
The partisan divide over the health-care plan was underscored in 2010, when the legislation passed a then-Democratic-controlled Congress with no Republican votes.
Republican leaders now are mapping out a legislative response to a possible Supreme Court rejection of that law, which is intended to expand coverage to at least 30 million uninsured Americans.
Advisers to Boehner, Senate Republican leader Mitch McConnell and other party leaders have held meetings in recent weeks to discuss the issue.
“We’re just going through different scenarios,” Republican Majority Whip Kevin McCarthy of California said earlier this month. “You’ve got to see what the ruling is.”
Representative Phil Gingrey, a Georgia Republican and a medical doctor, said his party has no major proposal on the drawing board.
“We don’t plan on coming out with an omnibus bill to replace Obamacare,” said Gingrey. “The American people don’t like that,” he said. “We certainly don’t want to try to cram something down their throats.”
Almost seven in 10 Republicans say the law should be repealed, according to the Bloomberg poll. Support for keeping it in place with minor changes is shared by 43 percent of independents, 17 percent of Republicans, and 64 percent of Democrats.
Leonard Gosselin, a 58-year-old disabled veteran from Raymond, New Hampshire who gets his health care through the Veterans’ Administration, said he’s opposed to the insurance requirement.
“I feel sorry for the rest of the people” who have to buy insurance, said Gosselin, a Republican. “I don’t like that at all.”
Fifty-eight percent of Americans say the quality of health care they are receiving is about the same as last year at this time, while 18 percent said they are worse off, the Bloomberg poll found. At the same time, 36 percent said they are worse off in what they pay for health care through premiums, co-pays or deductibles than last year -- a seven-percentage point increase from September 2009. Forty-one percent said it’s about the same, and 8 percent said they’re better off.
Supreme Court Politics
One belief unites most Americans: 71 percent say politics will influence the Supreme Court’s decision, with just 20 percent saying the court will decide solely on legal merits. Five justices are Republican appointees, and four are Democrats.
The poll of 1,002 adults has a margin of error of plus or minus 3.1 percentage points. It was conducted by Des Moines, Iowa-based Selzer & Co.
Another survey, an AP-GfK poll conducted June 14-18, showed that 77 percent of Americans want the president and Congress to start work on a new health-care bill if the Supreme Court rules the law unconstitutional. Forty-seven percent said they oppose the 2010 measure and 33 percent expressed support.
To date, no legislation to fully replace the law has come to the House floor, nor does it appear on Majority Leader Eric Cantor’s summer priorities list.
Republicans executed the first half of their “repeal and replace” promise soon after taking control of the House in 2011. They passed a bill to repeal the law on Jan. 19, of that year -- with all 242 Republicans joined by three Democrats. The measure died in the Democratic-controlled Senate.
The next day, the House adopted a resolution charging four separate committees to hold hearings and move legislation based on a 13-point replacement plan that included a mandate to permanently fix a Medicare-reimbursement rate formula for doctors that frequently comes under review by Congress, increase the number of insured Americans and lower health-care premiums through increased competition and choice.
House Republicans have also voted 30 times to eliminate, defund or scale back parts or all of the health law, most recently approving a measure to repeal a 2.3 percent tax on medical devices set to take effect in January.
Aaron, of Brookings, said if the Supreme Court overturns the law, Republicans will be in no rush to come up with their own comprehensive plan on an issue that has damaged two presidencies, including that of Bill Clinton, a Democrat who failed to win congressional support for his 1993 plan to provide universal health care.
“What one is dealing with here are a set of institutions that determine how we’re going to be treated when we’re in our most vulnerable state, how we’re going to be treated when we’re fearful about death,” said Aaron. “It’s a hard problem.”