After months of criticizing Democratic healthcare proposals from the sidelines, House Republicans this week stepped up efforts to promote their own plan and challenge critics' efforts to portray the GOP as the "party of no."
Unlike the Democrats' strategy of trying to provide near-universal coverage and force other major changes to the insurance system, the Republican approach is an incremental one that would do far less to reduce the ranks of the uninsured. It would instead give priority to controlling healthcare costs.
The different goals and effects of the GOP bill are reflected in a preliminary analysis released Wednesday evening by the Congressional Budget Office, which put the bill's 10-year price tag at $61 billion. That is far less than the $1 trillion estimate for the Democratic bill that House leaders plan to bring to the floor as soon as this weekend.
But the CBO analysis also concluded that under the GOP plan, 52 million nonelderly Americans would have no insurance in 2019 -- even more than the 50 million in 2010. By comparison, the House Democratic bill would reduce the number of nonelderly Americans without coverage to around 18 million over the next decade.
The GOP bill is an amalgam of market-oriented measures that would limit medical malpractice lawsuits, expand the use of tax-sheltered medical savings accounts, let people shop for insurance outside of their own states, and make it easier for small businesses and hard-to-insure people to get coverage. The ideas reflect conservatives' suspicion of sweeping new programs, federal spending and additional regulation.
Unlike the Democratic plan, it does not include subsidies or other provisions that would make coverage more affordable to people of modest means.
"What we've learned over many, many years is that the reason people don't have insurance is that they can't afford it," said Drew Altman, president of the Henry J. Kaiser Family Foundation, an nonpartisan health policy research group. "You can't make much progress toward helping the uninsured unless you help them buy it."
The Republicans' proposals long have been on their wish list, yet they were not enacted even when the party controlled Congress and the White House. And they are being resurrected at a time when some Republicans warn that the party is in danger of being seen as guardians of an unpopular status quo in healthcare.
"Come campaign time, voters need to know what healthcare reforms Republicans have supported," said Whit Ayres, a GOP pollster.
House Democratic leaders on Wednesday laid the groundwork for a Saturday vote on their massive healthcare legislation, after settling on a compromise to defuse disagreement in their own ranks over how to restrict federal funding for abortions.
The proposal does not differ substantially from one in the original bill that required consumers to pay for any abortion benefit with their own money, rather than with federal insurance subsidies. Senior Democrats hope that by tightening that restriction further, they will be able to satisfy enough socially conservative Democrats to get a majority.
President Obama is going to Capitol Hill on Friday to meet with House Democrats ahead of the expected vote, according to a senior Democratic aide who requested anonymity when discussing the volatile healthcare issue.
Republicans, who harbor no hopes of passing their alternative plan during Saturday's scheduled debate, have spent months criticizing the Democrats' plan as an intrusive, expensive government program -- an argument with strong appeal for the party's conservative base.
Promoting their alternative "is an intentional strategic shift toward not being just the opposition party but trying to be the alternative party," said David Winston, a Republican pollster.
The Republican bill lacks many major elements of the Democratic proposal: There is no expansion of Medicaid, no requirement that individuals buy insurance, no penalties for employers that do not offer coverage, and no subsidies to help the needy pay premiums.
But the CBO analysis concluded that the Republican bill would reduce premiums by an average of 7% or more in 2016 for people who buy insurance on their own rather than through employers. For most people -- the 80% of people who have group health insurance -- premiums would drop less.
House Minority Leader John A. Boehner (R-Ohio) hailed that CBO finding. "The Republican plan will lower healthcare costs for American families, and that's good news for everyone struggling in today's economy," he said.
But Democrats focused on the finding that the bill would result in 83% of Americans being covered by 2019 -- about the same as now, and far less than the 96% who would be covered under the Democratic bill.
"Tonight CBO confirmed that the Republicans' only solution for health reform is to preserve the status quo," said Rep. George Miller (D-Martinez).
The GOP proposal does not include one of the most popular elements of the Democrats' plan -- a ban on denying coverage to people with preexisting conditions.
But the Republican plan has adopted some of the more modest Democratic provisions. It too would make it easier for young adults to remain on their parents' health policies. It also would end the controversial insurance practices of imposing annual or lifetime limits on benefits and of canceling coverage after a policyholder becomes sick.
And rather than give more power to the federal government to address the nation's healthcare problems, the Republican plan looks to states, market forces and individuals.
Their bill would provide aid to the states to form "high-risk" insurance pools that would cover people -- including those with preexisting conditions -- who cannot get coverage through their jobs or in the individual market. The GOP bill also would provide incentive grants for states that reduce premiums and the ranks of the uninsured.
Small businesses would be encouraged, but not required, to cover their employees under provisions that would make it easier to band together to get group rates.
To curb costs through increased competition, the GOP plan would make it easier for insurance companies to sell policies across state lines. And it would impose new curbs on medical malpractice lawsuits -- on the theory that healthcare inflation is fueled by defensive medicine and the rising cost of malpractice insurance.
To increase incentives for individuals to control their own health spending, the bill would expand the use of tax-favored health savings accounts. And it would allow employers to provide steeper discounts in insurance premiums to employees who adopt healthy lifestyles.
Noam N. Levey in the Washington bureau contributed to this report.