With their eyes on the 2012 election, Republicans are preparing to maximize conflict with Democrats over healthcare in the new Congress and minimize potential compromises, according to GOP strategists, lawmakers and lobbyists.
That strategy is setting the stage for a bitter stalemate on Capitol Hill over the next two years as the president and senior congressional Democrats dig in to defend their signature achievement.
"Republicans have successfully challenged the healthcare legislation once," said GOP strategist Frank Luntz. "They'll do it again."
Luntz, a leading architect of the Republicans' successful campaign to cast the healthcare legislation as a " Washington takeover," said Democrats would suffer further if they tried to defend the law. "Democrats have more to lose," he said.
In practical terms, the GOP approach will probably mean little congressional input over how the law is actually implemented. The Obama administration will retain broad authority to refine the law on its own, working with businesses, consumer groups, healthcare providers and state regulators, healthcare experts say.
While lawmakers deadlock on Capitol Hill, GOP leaders already have a target list of Democratic senators who are up for reelection in two years in traditionally red states including Missouri, Montana, Nebraska and Virginia.
"The next couple of years, in some ways, become about the 2012 elections," Republican healthcare lobbyist Dean Rosen said last week at an Alliance for Health Reform briefing in Washington.
The GOP tactics mirror those deployed by Democrats after their 2006 electoral sweep.
Then, Democratic House and Senate leaders who had won majorities on a promise to challenge President George W. Bush's Iraq war strategy bullied congressional Republicans by repeatedly forcing them to vote to support the unpopular war.
The Democrats' legislative campaign ultimately collapsed. Bush used his veto pen to block legislation mandating troop withdrawals. Within a year, the Bush administration's effort to stabilize Iraq with a troop surge showed signs of success.
Many Democrats think they too will be vindicated as the public sees more of the benefits of the new healthcare law.
Whit Ayres, a longtime GOP pollster, warned that Republicans risked a backlash if voters perceived them as more interested in scoring political points than in responding to voters' concerns.
"There is no particular love for the Republican Party in the electorate," he said at a recent Health Affairs forum. "Republicans are going to have to earn [voters'] support and earn their respect, and the way you do that is by governing responsibly."
Most of the healthcare law's major benefits — including its guarantee of coverage to all Americans — do not go into effect until 2014. And there are few signs the law is getting more popular.
In the interim, Republicans, who think the law was crucial to their electoral gains, are increasingly confident they can showcase its shortcomings and further weaken already tepid public support for Democrats.
"They are looking for ways to be very aggressive," said Michael Franc, who works closely with congressional Republicans as head of government relations for the conservative Heritage Foundation.
Republicans provided a preview of their strategy before the midterm election as House GOP leaders forced Democrats to vote in June and September on proposals to repeal provisions of the healthcare law.
GOP leaders have indicated they intend to do more when they control the flow of legislation in the House next year, with likely votes to defund the law and excise controversial parts such as cuts in Medicare spending and a new mandate requiring Americans to get health insurance.
Rep. Joe L. Barton (R- Texas), who is seeking to chair the House Energy and Commerce Committee, has promised investigative hearings of what he has said are Obama administration coverups and improper uses of taxpayer money to promote the law.
Barton's rival for committee chairman, Rep. Fred Upton of Michigan, said last week in an op-ed piece that his "very top priority" would be pushing legislation to further restrict federal funding for abortion services, another issue sure to stoke conflict with Democrats.
Former Senate Majority Leader Bill Frist, a Tennessee Republican who retired in 2007, said Republicans could help correct flaws in the sweeping law.
"The reality is that the law will largely remain intact. That being the case, it is important that it be made to work as effectively as possible," Frist said. "And there are lots of things that can be fixed or modified by working together."
Even supporters of the healthcare overhaul think there may be a need to modify requirements on large employers to provide coverage, loosen restrictions on insurers and ease pressure on fiscally strained states as they expand their Medicaid programs.
But Democrats have already rejected making major changes. Speaking to reporters after the midterm election, Obama said he did not think voters wanted the two sides to "relitigate arguments that we had over the last two years" over healthcare.
And Frist and others said Republicans had almost no incentive to work with Democrats, especially after Obama pushed through the legislation by using parliamentary tactics that circumvented GOP opposition.
"There is very little risk for Republican leadership," Frist said. "The American people don't like the bill. … And everything that happens in healthcare is now owned by President Obama. When rates go up, when states have to cut education to pay for healthcare, it will be seen as a product of the healthcare law."
Utah Sen. Robert F. Bennett, a conservative Republican who voted against the law but lost a primary challenge this year to a "tea party"-backed candidate, said he did not expect any meaningful debate on healthcare next year.
"I would hope Republicans would be responsible enough to say, 'All right, let's construct something that works,' which means, in my view, a bipartisan kind of effort," he said.
"But I'm afraid there may be some Republicans who say: 'Well, we won the 2010 election by bashing what the Democrats did on healthcare. Maybe we can win the 2012 election by the same strategy.' "