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What's Next: How Republicans Plan to Roll Back the Health Care Reform Law

House vote to repeal was only the first step

by: Patricia Barry | from: AARP Bulletin | January 20, 2011

The House Republicans' vote to repeal the nation's new health care reform law Wednesday was symbolic, but it did in fact signal the party's very real determination to overturn the law and block its implementation.

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"We will do everything we can to delay and defund provisions of the [law] so we can get some discussion going on how to replace it," House Majority Leader Eric Cantor (R-Va.) told reporters Tuesday.

Democrats meanwhile used the threat of repeal as an opportunity to promote new consumer benefits of the massive Affordable Care Act — such as abolishing exclusions of coverage for preexisting medical conditions in the individual insurance market, closing the Medicare coverage gap (the "doughnut hole") for prescription drugs and allowing young adults under age 26 to stay on their parents' insurance. "The debate … gives us a chance to remind people what it is that's at stake," Health and Human Services Secretary Kathleen Sebelius told reporters Wednesday, and "why we can't go back to where we were."

Public opinion on the law is still deeply divided, with 26 percent favoring total repeal, 25 percent wanting partial repeal, 21 percent preferring the law left as it is, and 20 percent wanting it expanded, according to a recent poll by the Kaiser Family Foundation.

These are some of the arenas in which the renewed battle over health care reform will be played out:

Revoking the individual mandate

So far, 25 states have joined Florida's lawsuit challenging the constitutionality of the law, mainly its requirement that people must buy health insurance or face a penalty or tax. In three other lawsuits, two federal judges have ruled that this requirement, known as the individual mandate, is constitutional, and the third held that it is not. All are expected to be decided finally by the Supreme Court.

If the court throws out the mandate, the law's core principle of having a national pool of insured people to bring down costs would be undermined. Insurance companies were willing to insure those with preexisting conditions in return for an expanded national pool that includes millions of new healthy customers. One alternative to the mandate, now under discussion, is to encourage people to buy insurance early by making it more expensive for those who delay, in much the same way that Medicare levies a permanent premium surcharge on those who sign up late.