Parties jockey on healthcare ahead of court ruling

WASHINGTON (Reuters) - Eric Cantor pulls no punches about what Republicans in the U.S. House of Representatives will do to "Obamacare" if the Supreme Court leaves any of President Barack Obama's healthcare reform law intact.

"We're going to take a bill to the floor that calls for the total repeal of Obamacare," the House majority leader said in a nationally televised press conference this month.

Why? "So that we can start over and we can tell the American people: we're on your side," the Virginia Republican explained. "We care about your health care, we want quality care and affordable prices for as many Americans that are there looking for that to happen."

What might sound like music to some voters' ears is also part of the political dance that Republicans and Democrats have started as they await a landmark ruling on the 2010 healthcare reform from the Supreme Court within the next two weeks.

In an election year, the political stakes are high on an issue which, many polls show, has divided the nation.

How the court's decision is framed politically, whether by the Democrats and Obama or the Republicans and their presumptive nominee Mitt Romney, could sway wavering independent voters that each side probably needs to win the November 6 election.

Obama and Democrats might stand to gain electorally from the ruling even if it overturns part of his landmark policy achievement.

But up to now, Republicans have dominated the political message on healthcare with calls to "repeal and replace" the law, condemned by conservatives as a government intrusion into the lives of private citizens that will only waste taxpayer money and drive healthcare costs higher.

The repeal vow seems to be resonating among voters angered by a provision known as the individual mandate, which would require most Americans to obtain health coverage by 2014.

After about a year when polls showed Americans pretty evenly divided on healthcare, surveys may have begun to sway the Republicans' way. A recent CBS News/New York Times poll showed nearly 68 percent want at least some of the law overturned.

Given that, congressional Republicans including Cantor are unlikely to wander far from the repeal message. Some worry that the attack strategy could suffer if the party tried to forge a detailed plan of their own, an effort that could also show disunity within Republican ranks.

Senior Republican House aides say between now and Election Day, leadership will focus on expressing support for general "principles", their basic ideas for replacing Obama's reform.

"I would expect that you'd see that the day the Supreme Court announces its decision," said Senator John Barrasso, a physician who chairs the Senate Republican Policy Committee.

Republican plans include purchase of insurance across state lines, creation of new insurance pools by civic organizations and other groups, insurance portability for people who change jobs, limiting malpractice lawsuits and wellness incentives.

Romney himself, in a tight battle with Obama for the White House, has provided little more than general outlines for a "consumer market" healthcare system.

After 26 U.S. states and an independent business group asked the high court to overturn the law, the justices have three basic choices: uphold it, strike down selected provisions or overturn the entire legislation.

OBAMA'S MESSAGE

Legal experts say the court is least likely to kill the whole law, an outcome that would damage Obama and strongly reinforce Republicans' claims that the lengthy 2009 healthcare reform debate was a costly distraction from the more important priorities of the economy and jobs.

Striking down the whole law could help Obama energize his base of voters. But the effect would likely be less favorable on independent voters, who could be swayed by Republican counter-claims that such a court ruling proves Obama's policies wrong.

"Democrats would not be able to resist the temptation to attack the court as an instrument of a conservative effort to undo not just the Obama administration but 75 years of American history dating back to the New Deal," said William Galston of the Brookings Institution.

A ruling that upholds the law would make Obama and the Democrats uncontested winners by sweeping away allegations that the law is unconstitutional and potentially undermining the credibility of Republican attacks in the minds of voters.

It would also give Obama a stronger hand against Romney, who oversaw a similar state reform law as governor of Massachusetts but who has denied that the same plan can work nationwide.

Analysts say the court could also help Obama if it were to strike down only the individual mandate. Its disappearance would make coverage for some uninsured people more expensive. But politically, it could protect the president and his party from the sharpest Republican attacks by removing the feature that voters find most objectionable.

"There'd be a problem for Republicans, because the ?boogey man' would be gone," said one Democratic adviser.

REPUBLICANS AND INSURERS

Democrats are already seeking to cast Republican calls for repeal of the healthcare law as a partisan defense of an insurance industry with campaign donations that favor Republicans over Democrats by a 2-to-1 margin, according to the nonpartisan Center for Responsive Politics, which tracks campaign contributions.

Republican lawmakers and senior aides say they could be ready to put forward "remedial" legislation to allow millions of people already receiving benefits to continue for a time.

Those could include 60,000 people with preexisting conditions now covered by a reform program, senior citizens who receive help paying for prescription drugs and young adults allowed to stay on their parents' plan through age 26.

"Those kinds of things, if they're to be affected, ought to be affected in a way that makes for a smooth transition for people," said Rep. Tom Price, a Georgia Republican and physician who heads the House Republican Policy Committee.

But Republicans would have difficulty extending those advantages to the general populace because of opposition from conservatives including Tea Party members who reject any suggestion of adopting provisions of "Obamacare."

Three leading health insurers - UnitedHealth Group Inc, Humana Inc and Aetna Inc - have decided to retain some of the Affordable Care Act's more popular provisions including low-cost preventive services and a measure allowing adult children to remain on their parent's health plans through the age of 26.

But Republicans would still have to address protections for those with preexisting conditions.

In a filing, the administration has advised the court to strike down popular protections including the one for preexisting conditions if justices do away with the individual mandate. That is because without a mandate to require younger healthier people to buy insurers, companies could face financial risks from large numbers of sicker, older consumers.

Some Republican aides said that fixing the law would be responsibility Democrats, who crafted the legislation and control both the White House and Senate.

But the preexisting conditions protection is extremely popular with voters, favored by 85 percent of Americans, according to CBS and the New York Times.

Conservatives who object to adopting the protection for all with preexisting conditions say Republican leaders have already assured them that any action would be done narrowly for an estimated 60,000 people already receiving coverage under the Affordable Care Act.

"They went out of their way to tell us that they were completely committed to full repeal," said Dean Clancy, vice president for healthcare at grassroots lobby group FreedomWorks, which has been a driving force behind the Tea Party movement.

(Editing by Alistair Bell and Eric Walsh)

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