The Weekend Australian

By Lesley Russell

There's considerable irony in the fact that the first major policy marker of the new Republican majority in the House of Representatives -- the vote to repeal healthcare reform -- may have improved public support for the law and left Republicans on the back foot. Voters are increasingly angry with Republicans for the same reason they were angry with Barack Obama: they see efforts to boost employment and the economy as the top priority.

Polls show opposition to healthcare reform is slowly subsiding. People apparently developed an opinion very early on, and the heated political arguments and the flood of analyses have done little to change their minds. But they want to hang on to every new benefit that arises, so as implementation proceeds, public support grows.

The Obama administration and congressional Democrats' full-throated campaign to defend the healthcare law and increase support for the measure seems to be working. For this reason the Republicans have moved from repeal, to repeal and replace.

Their substitute for the current complete, if imperfect, reform package is an unspecified grab bag of measures that are, largely, the same as those already enacted. There's no vision, no strategy, no coordinated plan.

The GOP now faces the same daunting challenge as President Obama and the Democrats: reconciling the difficult and politically sensitive trade-offs that come with trying to provide more and better healthcare, while also controlling costs. That balancing act is one reason Obama's healthcare law is so complicated. And it explains in large part why GOP leaders never produced a comprehensive alternative during the debate over the Democratic legislation or the 2010 congressional elections.

The plans they've proposed -- generally sophisticated versions of robbing Peter to pay Paul -- don't stand up to tough scrutiny. They do nothing to expand the workforce, tackle health disparities, rein in costs or reduce the deficit.

Republicans have demonstrated they can craft less costly health legislation that does not require new taxes or cuts in Medicare spending. But their 2009 bill included just $61 billion in new spending over 10 years, compared with more than $900bn for the health law Obama signed. This approach is projected to leave 52 million Americans uninsured by 2019. Republican lawmakers haven't indicated how, or even if, they plan to expand coverage.

So far, the Republican leadership is remaining tight-lipped about how or when they'll deliver their vision of something better. Yet they'll have to submit their policies for costing by the same Congressional Budget Office whose numbers on the Democratic policies they chose to reject.

Democratic Senate leaders have vowed to shelve the repeal bill, and Obama has said he'll veto it if it ever reaches his desk. With these threats in mind, GOP leaders have promised to fight the healthcare law in other ways. House Majority Leader Eric Cantor has said Republicans will "do everything we can to delay and defund the provisions of the bill".

The Republicans' choice to focus on repeal -- described by some commentators as a charade -- at the expense of real issues such as jobs is backfiring for them among their constituencies. "The House majority is setting out to prove they'd rather waste time on empty legislation than confront the real issues facing this nation" screamed one headline, echoing the tone of many others.

In particular, commentators are tackling the GOP's deceptive repeal reasoning. Conservatives say they must defeat the law because it increases federal deficits. But this claim is false. The nonpartisan Congressional Budget Office makes that clear, saying repeal would drive up the deficit by $230bn over the first decade. That's why the Republican leadership exempted the repeal bill from the deficit reduction rules.

So Washington faces a challenge between "repeal and reform" and "implement and improve". In a statement about the repeal vote, Obama cited the law's new consumer protections, added benefits for senior citizens and reductions in deficits, as well as repeating a pledge to consider changes. "So I'm willing and eager to work with both Democrats and Republicans to improve the Affordable Care Act, but we can't go backward."

Perhaps Republicans should take advice from former Senate majority leader Bill Frist. "It is not the bill that [Republicans] would have written," the Tennessee Republican said. "It is not the bill that I would have drafted. But it is the law of the land and it is the platform, the fundamental platform, upon which all future efforts to make that system better, for that patient, for that family, will be based. And that is a fact."

Republicans and Democrats will be required to work co-operatively with the Obama administration to tackle the deficit, get more people back to work, make social programs sustainable into the future, and address the growing disparities in opportunity, health and income that beset the nation. That's what voters sent them to Washington to do.

Lesley Russell is a senior fellow at the Center for American Progress in Washington DC, and a research associate at the Menzies Centre for Health Policy and the US Studies Centre, both at Sydney University.