海角大神

The struggle over the future of health-care reform is just beginning.

After what Speaker John Boehner dubbed 鈥渁 spirited but respectful debate,鈥� the House voted 245 to 189 Wednesday to repeal President Obama鈥檚 signature domestic achievement 鈥� health-care reform.

But with Senate Democrats opposed to allowing a floor vote on the bill 鈥� and a president sure to veto it 鈥� the near party-line vote is the likely high-water mark for repeal in this Congress.

Wednesday鈥檚 vote kicked off an offensive on both sides of the aisle 鈥� and within parties 鈥� on what House majority leader Eric Cantor of Virginia called 鈥渁 better way forward.鈥�

For House GOP leaders, the next phase will include the intense oversight of all aspects of the vast reform legislation while simultaneously attempting to dismantle it, brick by brick.

Tea party activists, led in the House by Rep. Michelle Bachmann (R) of Minnesota, pledge to carry the fight for outright appeal into the 2012 elections. 鈥淲e will not stop until we put a president in the White House who will repeal this,鈥� she said.

For Democrats, it鈥檚 a chance to defend their legacy, including within their own ranks. In the 2010 elections, moderate Democrats took a pounding on health-care reform, but Wednesday most rallied with their own leadership to oppose repeal of a reform they once opposed. Three voted for repeal: Reps. Dan Boren of Oklahoma, Mike McIntyre of North Carolina, and Mike Ross of Arkansas.

Instructions to committees

The next order of business is a vote to empower committees to propose measures to replace the health-care law. On Thursday House Republicans take to the floor a bill that instructs four committees 鈥� Education and the Workforce, Energy and Commerce, Judiciary, and Ways and Means 鈥� to propose changes to existing law that cut costs, end regulations that hurt job creation, and maximize patient access and choice.

鈥淭his majority is dedicated to growth for the American people. Repealing last year鈥檚 health-care law is a critical step,鈥� majority leader Cantor said in closing remarks on the floor Wednesday. The next step, replace the law, begins 鈥渁n honest debate about a better way forward,鈥� he added.

But Democrats are saying this 鈥渞epeal and replace鈥� agenda is a chance to more effectively explain and defend existing reform in committee hearings, on the floor of the House, or on the stump in the run-up to 2012 elections.

鈥淚t gives Democrats a further chance to talk to the American people,鈥� said Rep. Sander Levin of Michigan, the top Democrat on the House Ways and Means Committee. 鈥淲e are on the offensive on this issue. We are going everywhere. We are an American truth squad.鈥�

The new Republican majority in the House aims to set committees to work investigating 12 issues to include in new health-care reform legislation, many focused on lowering the costs of health care.

These include: cutting regulations that discourage job creation, lowering health-care premiums through competition, preserving options for patients to keep health plans that they like, and creating affordable options for people barred from insurance because of preexisting conditions. These are issues on which Republicans hope to find some bipartisan support.

Points of contention

But other proposed committee assignments are more divisive, both between and within party ranks. One is the charge to reintroduce legislation to limit medical malpractice claims and cut the costs of defensive medicine 鈥� a move strongly opposed by trial lawyers, a key constituency for Democrats. Another is to find ways to ensure that public health-care funds are not used to pay for abortions, including providing 鈥渃onscience protections for health-care providers.鈥� The language over abortion rights nearly scuttled heath-care reform in the last Congress, as social conservatives broke ranks with their Democratic leaders.

Yet another flashpoint is entitlement reform. Republicans propose requiring committees to find ways to pay for health reform that do not impose new tax burdens or 鈥渁ccelerate the insolvency of entitlement programs.鈥� Current law anticipates a $500 billion cut in Medicare. Panels are also tasked with giving states more flexibility to administer Medicaid programs. Instead of a mandate for people to purchase health insurance, Republicans propose 鈥渋ncentives to encourage personal responsibility for health-care coverage and costs.鈥�

A leading GOP criticism of health-care reform is that it pays for itself by raising taxes and fees, not by lowering the cost of providing health care. By focusing attention on discrete cost issues, GOP leaders hope to find a consensus on alternative legislation.

"We will use every tool at our disposal to dismantle this law and develop a better path forward," said Rep. Fred Upton (R) of Michigan, who chairs the Energy and Commerce Committee, in a statement after Wednesday鈥檚 vote.

"We will undertake rigorous oversight of the law as it stands, examining sound alternatives through a transparent, inclusive and deliberative process. We must focus on lowering costs, which the American people wanted but the Democrats ignored," he added. "We will also look to our governors, who are demonstrating great leadership and innovation, but who are shackled by federal red tape and mandates."

Affordable care is joint goal

Democrats say they are open to reforms, especially those that lower costs. Moreover, any good ideas that come out of the next months of committee effort could be used to improve existing law, not just replace it, they add.

鈥淏ringing affordable care to Americans has long been the goal of both parties,鈥� said House Democratic whip Steny Hoyer of Maryland.

鈥淲e have a bill that expanded coverage, put new regulations in place, but it鈥檚 not clear it cuts the cost of health care,鈥� says Julian Zelizer, a congressional historian at Princeton University in New Jersey. 鈥淭hat鈥檚 a criticism you saw from left, right and center.鈥�

鈥淚f the debate moves in that direction, there鈥檚 room to form some kind of bipartisan support for more stringent cost controls,鈥� he adds. 鈥淏ut on the other hand, both parties also have a stake in posturing going into 2012 elections.鈥�