Tactics change in health law fight

In stark contrast to the last congressional session, Republican lawmakers have introduced only a handful of bills to strike down or dismantle President Obama’s health care law in the first weeks of the new Congress — the latest indication that the epicenter of debate over “Obamacare” has shifted to the nation’s statehouses.

Two years ago, as the 112th Congress convened, opponents of Mr. Obama’s signature achievement rushed to gut the Patient Protection and Affordable Care Act right out of the gate.

Besides 14 attempts to repeal all or key portions of the law, three bills introduced in January 2011 would have prevented the Internal Revenue Service or Treasury Department from hiring anyone to carry out tax provisions in the reforms, and two would have cut off funding for the law, according to a Washington Times review of health care-related bills.

In 2011, the bills targeting the health care act rolled out with names that ranged from the blunt — “Repealing the Job-Killing Health Care Law Act” — to more subtle titles like the “Empowering Patients First Act.”

But this year, only a pair of bills from Reps. Michele Bachmann, Minnesota Republican, and Steve King, Iowa Republican, call for an outright repeal of the president’s health reforms.

Sen. Mike Johanns, Nebraska Republican, sponsored a bill that would repeal the “individual mandate” requiring most persons to buy insurance, while Rep. Scott Garrett, New Jersey Republican, reintroduced a bill from the last Congress that would eliminate the tax provision of the law that gives the mandate teeth. A Democrat, Rep. John Barrow of Georgia, filed a bill to repeal the individual and employer mandates of Mr. Obama’s law.

But Rep. Paul Ryan, Wisconsin Republican and former vice presidential candidate, signaled the GOP is turning its focus to the implementation of Mr. Obama’s law.

“In the president’s first term, we argued against big government in theory,” Mr. Ryan told the National Review Institute.”In his second, we will argue against it in practice.”

In the previous Congress, the flurry of early legislative attacks against the health care law arrived before the Supreme Court upheld the individual mandate, which had been considered the most controversial aspect of the law. Mr. Obama then secured a second term, thwarting House Republicans’ hopes to destroy his law in the face of a Senate that also remains under Democratic control.

“I do think the House has realized there’s no practical possibility of repealing the ACA,” said Timothy Jost, an expert on the health care law at the Washington and Lee University School of Law. “And frankly, their constituents aren’t interested in seeing them continue to do this.”

The most tangible efforts to erode the health care law are occurring in state capitals across the country. Nearly half of the states have declined to set up state-run exchanges — which burdens the Obama administration with setting one up for them. And some GOP-led states are also declining to expand Medicaid eligibility — a provision of Mr. Obama’s law that the Supreme Court deemed optional.

To be sure, legislative attempts to dismantle the law are not disappearing completely from Capitol Hill. Rep. Phil Gingrey, Georgia Republican, plans to resubmit two bills, the SCOPE Act and the Provider Shield Act, that would prevent “one bureaucrat” in the Obama administration from deciding whether a physician is providing adequate care and make sure doctors are not exposed to new liability standards under the health care law.

“The GOP is committed to full repeal, but Republicans are also targeting specific parts of the law for repeal,” Gingrey spokeman Jen Talaber said.