Just as several provisions of the new health care law went into effect this week, Republicans unveiled a campaign agenda that vows to repeal the overhaul and replace it with far more limited changes.
But could Republicans really get rid of the law?
The answer is probably not, NPR health policy correspondent Julie Rovner tells guest host Mary Louise Kelly on Weekend Edition Saturday.
Even if the GOP were to win control of the House and Senate in November elections, Rovner says, any repeal legislation is certain to be vetoed by President Obama. Republicans would need a two-thirds majority in both houses to avoid a veto, which she says seems highly unlikely.
In its "Pledge to America," a blueprint for what the party would do should it retake one or both houses of Congress, the GOP lays out its own ideas for improving health care. The document proposes to do away with health care mandates on small businesses, allow the purchase of health care across state lines and enact "real medical liability reform."
"We will repeal the health care [law] and then we will replace it," Rep. Kevin McCarthy of California told NPR after the pledge was announced Thursday in Sterling, Va.
Rovner points out that "mostly these are things that we've seen before, that Republicans have been talking about for years — things like capping damages in medical malpractice lawsuits, and allowing people in one state to buy insurance in another state."
But she says there's one major difference between then and now: the consumer protections that took effect this week.
As of Thursday, insurers can no longer impose lifetime caps on benefits and must allow parents' plans to cover young adults up to age 26. Companies also can't cancel policies retroactively unless they can prove fraud, and they can't discriminate against children with pre-existing health conditions.
These protections essentially amount to an implementation of much of the "patients' bill of rights" that kicked around Congress in the late 1990s and was aimed at curbing insurance industry practices, Rovner says.
The timing of the new provisions — coming six months after President Obama signed the health care bill into law — is hardly coincidental, Rovner says.
"The people who wrote this bill knew that it was going to take a good long time to get the major benefits up and running, so they wanted to have something tangible and popular to show voters before those important midterm elections," she says.
Republicans seem to want to let the new benefits stay in place, Rovner says, noting that the patients' bill of rights was mostly bipartisan.
Both parties are having problems with the insurance industry, she says. And that industry doesn't support many of these changes unless they're also accompanied by a requirement that everyone have health insurance — something that's at the top of the Republican hit list.
The chief executives of Assurant Health, Golden Rule Insurance and Wellpoint testified at a congressional hearing last year that without such a mandate, they couldn't even cope with modest changes to the health care system such as selling policies to people with pre-existing conditions.
Some of the largest companies, such as Aetna and Cigna, said this week that they intended to stop selling policies only for children rather than abide by the new law.
"Bottom line," Rovner says, "is that even doing the more popular thing is difficult in health care without doing the less popular thing."