Almost since the moment the health overhaul became law, its Republican opponents have called for its repeal — some GOP lawmakers have even advanced legislation to achieve this end.
As part of the run up to the November elections, the Heritage Foundation, a conservative Washington think tank, has established an "action arm" to push for repeal. Much of the focus involves tapping into what it characterizes as significant grassroots backing. The group has enlisted the help of 74 conservative organizations to talk to lawmakers.
The ultimate goal of the effort, according to Michael Needham, who is spearheading it, is to get lawmakers to vote on repealing the law. There are 170 Republican signatures currently on a discharge petition to bring a repeal bill to the House floor — but they need 218 to get it there. So Heritage Action is now eying Democrats who voted against passage of the health law. And, despite the long odds against repealing the law anytime soon, Needham says the prospects of success are good, even if it takes another four years and a new Congress.
He recently spoke with Kaiser Health News' Andrew Villegas on the details of Heritage Action's strategy.
Q: What are the prospects for repealing the health overhaul law?
A: First of all it's going to be a multiyear effort. Obviously it's going to be difficult to get Obamacare repealed as long as President Obama would have the ability to veto any repeal legislation. It's important remember that in 1988 the Senate overwhelming passed the Medicare Catastrophic Coverage Act and then repealed it one year later because Americans, especially American seniors, saw the costs that program had and saw that the benefits were underwhelming based on what they were promised. And so in 1989 we had a repeal effort of a major piece of health care legislation that passed with I believe 77 senators voting in favor of it, so there is a precedent for repealing these types of bills.
Q: Do you think that the path forward gets muddy if Republicans don't take a lot of seats in November?
A: No. Look, I think that at the end of the day, the American people are speaking with a loud voice. Fifty-eight percent of Americans consistently in poll after poll are saying that they support repeal of Obamacare, and so I think on some level the will of the American people is going to be heard. … Our discharge petition has  Republicans that have signed it. No Democrats have signed it yet. So clearly, the Republican Party is more in tune with the American people right now on this issue than the Democratic Party, which seems to be avoiding the conversation. But it needs to be a bipartisan effort. … I don't think anybody predicts that the Republicans are going to be able to get cloture on a repeal in the Senate next year without Democrats.
Q: How do you expect the repeal process to unfold? What are some of the steps involved?
A: I think there are a number of Democrats who are strongly against Obamacare. When you look at Mike McIntyre down in North Carolina, when you look at a guy like Bobby Bright [of Alabama] or Walt Minnick [of Idaho], Heath Shuler [of North Carolina]. There are a number of Democrats who understand that the costs of Obamacare — what it does in terms of debt that we're going to pass on to our children and our grandchildren; what it does in terms of getting in the way of the doctor-patient relationship — is the wrong path for the American people. And many of them voted against Obamacare and some of them have even said since then that they favor starting over with a clean slate. So [what has to happen] is for some of these Democrats ... to take that next step.
Q: A lot of people are viewing repeal talk as largely symbolic with an eye toward the future. Do you think it's a symbolic gesture?
A: No, I think this is a 100 percent authentic effort to repeal Obamacare because we're seeing the impact. … Grand slams happen in the course of a baseball season, and this is something that I think is going to happen.
Q: What do you think are good Republican ideas to replace Democrats' health reforms?
A: The American health care system is set by a peculiarity in the tax code … where there's different tax treatments for employer-based health insurance purchases than there is for [plans bought] on the open market or the individual market. I think … having tax reforms that treat all health care purchases equally so people aren't penalized for leaving their job or losing their job or from being independent contractors … is absolutely critical to creating a true market where the forces bring down costs and improve the quality of every other [insurance] product. I think being able to buy health insurance across state lines [and] freeing state governments to experiment with Medicaid within certain bounds such as they were allowed to experiment with welfare reform in 1996 — these are all sorts of ideas that various Republicans have talked about …, but more importantly, that conservative, free-market health care economists have been promoting — are the right direction for our country.
Q: In your opinion, are any parts of the health law salvageable?
A: I think at the end of the day it's pretty clear. … The costs are going to go up. It's going to put huge costs on small businesses. The overwhelming majority of the stuff in the bill is going to be harmful to the system and the best way [forward] is to repeal the whole thing and then we can sit down and move on. But I don't see any value in taking the current bill that was rammed through Congress and splicing and dicing that one because the American people want it repealed and that's what should happen before we talk about where to go from there.
This story was produced through collaboration between NPR and Kaiser Health News (KHN), an editorially independent news service and a program of the Kaiser Family Foundation, a nonpartisan health care policy organization that isn’t affiliated with Kaiser Permanente.