For those who thought "death panels" were so '09, or that President Barack Obama settled the matter when he signed the overhaul into law, think again. If there is one issue that promises to unite Republicans everywhere, it's the federal Patient Protection and Affordable Care Act. Consider:
- The next speaker of the House, John Boehner, has pledged to repeal and replace what Republicans derisively call "Obamacare."
- Sarah Palin, when asked by Time magazine what she would do if elected president in 2012, said "the first priority 'of the next Republican president' should be 'to sign a bill for the repeal and replacement of Obamacare with true free-market, patient-centered reform.' "
- Republican governors, from Minnesota presidential hopeful Tim Pawlenty to Rick Perry in Texas, to those who haven't even taken office yet, such as Wisconsin's Scott Walker, have balked at implementing the health care law in their states.
- GOP legislators in 40 states have introduced bills to block all or part of the law.
- State attorneys general, most of them Republicans, have gone to court to challenge the constitutionality of the law's "individual mandate," which in order to create a large enough risk pool for insurers requires most Americans to have coverage or pay a penalty.
Harry Hamburg, AP
House Minority Leader John Boehner of Ohio stands behind a copy of the Democrats' version of the health care bill during a news conference on Capitol Hill in Washington on Oct. 29, 2009.
The law is likely to end up at the U.S. Supreme Court. Until then, critics say the court of public opinion gives them a potent political issue.
"Obamacare is the biggest example of government overreach we've ever seen," said Mike Connolly of the fiscally conservative Club for Growth. "It is the single greatest threat to economic freedom and growth, so it will remain a huge and defining issue for the 2012 campaign."
Tom Borelli of the National Center for Public Policy Research, a conservative think tank here, said there is "tremendous momentum" among the voters behind GOP gains: "Rolling back Obamacare is the top priority for tea party activists."
Frank Luntz, the GOP message guru who counseled Fox News commentators to always talk about "government-run" health care, said as the presidential primary takes over the national political debate, Republican lawmakers "will be driven to undermine Obamacare in every way possible. GOP primary voters want nothing short of repeal and they don't want compromise."
Risks and Rewards
But if Republicans focus on "Obamacare," will they make the same strategic mistake Democrats were accused of in the last election -- namely, putting the issue of health care over jobs and the economy? Despite passage of the historic legislation, voters did not give Democrats the credit some thought they deserved.
Yet as the law gradually takes effect, the potential for political rewards -- and risks -- rises.
"It is absolutely going to heat up and be a hot topic through 2014," when most provisions will be implemented, said Erikka Knuti of the Health Information Campaign, a consumer education group that supports the law. "If they [Republicans] make repeal of health care their central platform, they're leaving themselves up for big problems and backlash. Nobody's going to want to go back to being denied coverage for a pre-existing condition."
Yet that is exactly where many new members of Congress want to go. North Carolina's Renee Ellmers, a Palin protege, opposes requiring insurers to accept patients with pre-existing conditions -- including pregnancy. Austin Scott of Georgia, another House freshman, was asked if there was any part of the law he supported. He replied, "No, ma'am, there are not."
Ideologically tough attitudes like those have raised questions about whether Boehner will be able to control the "Tea Party Congress" or if new members will adjust their thinking to congressional reality.
If polls are to be believed, both may have to reconsider their positions.
While a slight majority opposes the health care law, there is evidence that many people like individual provisions such as allowing children up to age 26 to stay on their parents' insurance. The latest Kaiser health tracking poll revealed just a quarter want all or part of the law repealed.
'Repeal' or 'Repeal and Replace'?
Republicans have adjusted their slogan from "repeal" to "repeal and replace." Yet even that will be difficult. They may have new power in the House and more seats in the Senate, but Republicans still lack enough votes to overcome a filibuster or override a presidential veto.
House Republicans will, however, be able to highlight the 906-page law's costs and uncertainties in oversight hearings that could "convince people that the plan is an administrative nightmare," said John Pitney, a former GOP Hill staffer who teaches at Claremont McKenna College in California. "The risk for Republicans is that they might botch the 'replace' part of the 'repeal and replace' approach."
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Even before the 112th Congress convenes, Republicans can claim at least a small victory, though. The Obama administration has retreated on a tax reporting requirement that businesses found onerous. But on the big things like health insurance exchanges and the individual mandate, Democrats are unlikely to budge. They'll get help from liberal groups that are painting GOP lawmakers as "health care hypocrites" who accept federally subsidized coverage but oppose it for 32 million uninsured Americans.
Luntz says Republicans must tread carefully not to alienate independents and centrists who may not like much of the health care law but do want changes made. "Republicans can't just call for the repeal of Obamacare," he said, "they need a clearly defined alternative."
But time, supporters say, is ultimately on their side.
"Benefits are beginning to play out," said Judy Feder, senior fellow at the liberal Center for American Progress. "The burden is on the opponents. They have a tough row to hoe to take it away."