Reform Update: Apparently giving up on repealing the ACA, House GOP forming an alternative

Whether it's the 2014 election cycle or President Barack Obama's most recent public challenge that's spurring them to action, House Republicans are poised to offer an alternative to the president's healthcare law this year.

In the three years since they regained control of the lower chamber, House Republicans have promised to “repeal and replace” the Patient Protection and Affordable Care. So far, they have made good only the “repeal” portion, passing some 40 bills to overturn the controversial 2010 law in whole or in part.

But those repeal efforts have abated now that the law's major provisions are becoming entrenched. A series of actions and events in Washington last week indicate that the House leadership will introduce an ACA replacement bill in the coming months.

“The Republicans are finally going to end the free ride they've had on opposing Obamacare to offer an alternative,” said David Kendall, a senior fellow for health and fiscal policy at Third Way, a think tank that pursues centrist policies. Kendall added that he's not sure if that's because Republicans did not like being mocked in the president's State of the Union speech, or because they believe they now have an opportunity to seize the upper hand because of the law's botched rollout. “Regardless of the reason,” he said, “it will be nice to have a side-by-side comparison of Obamacare and a Republican plan.”

In his first State of the Union address since his healthcare law's coverage provisions kicked in, Obama spent little time on healthcare—but enough to chastise Republicans for trying to overturn the ACA and to challenge them, again, to produce something better if they can.

“So again, if you have specific plans to cut costs, cover more people and increase choice—tell America what you'd do differently,” he continued. “Let's see if the numbers add up. But let's not have another 40-something votes to repeal a law that's already helping millions of Americans.”

House Speaker John Boehner (R-Ohio) recently said that healthcare reform would be a topic of interest at the House GOP retreat, which began on Maryland's Eastern Shore a day after the president's State of the Union address. The party made good on that promise. House Majority Leader Eric Cantor (R-Va.) said during the three-day meeting that the House GOP would support an Affordable Care Act alternative and pass that legislation on the House floor this year, according to a House GOP leadership aide.

So far, the GOP healthcare plan is thin on details. A one-page fact sheet outlining the standards for replacing the ACA includes a mission statement and fewer than 10 “guiding principles,” such as “give healthcare security and peace of mind to all Americans,” “incentivize doctors to practice more medicine,” and “find new cures and better treatments through innovation.”

Third Way's Kendall said he expects the GOP alternative to include provisions such as block grants for Medicaid and multi-state purchasing of healthcare insurance (so a person in New York can purchase a health plan regulated in Texas, for instance).

“The only way it can resonate is if they offer a way to fix the healthcare system and Obamacare,” Kendall said. “If they continue to play to their base and repeal Obamacare and not do anything, that gets them elected in their primary elections in their district, but it doesn't win them a general election.”

In the upper chamber, Senate Minority Leader Mitch McConnell (R-Ky.), along with Sens. Lamar Alexander (R-Tenn.) and John Barrasso (R-Wyo.) wrote to the nation's Republican governors this week, asking for their input on an ACA alternative. “We believe this law is flawed beyond repair, and the only true solution is to repeal Obamacare,” they wrote to Tennessee Gov. Bill Haslam, chairman of the Republican Governors Public Policy Committee. “But that's not enough. Obamacare must be replaced with reforms Americans support. We have advocated some of these types of reforms for many years, approaches like insurance policies tailored to those with pre-existing conditions, promoting wellness and reining in junk lawsuits.” The senators also emphasized that any reform would require a true partnership between the federal government and the states.

A new report from the Commonwealth Fund examines how the 50 states and Washington, D.C., have so far carried out three reforms in the ACA that were established to help more Americans gain access to health insurance coverage: the implementation of market reforms, the establishment of the health insurance exchanges, and the expansion of Medicaid eligibility for low-income adults.

Negotiations to permanently repeal Medicare's physician payment formula will heat up in the coming weeks as lawmakers negotiate a final bill and determine how to pay for repealing the SGR. Some say a solution could come sooner rather than later, as lawmakers discuss the nation's debt limit and Sen. Max Baucus (D-Mont.) wants to finish the task before he leaves Congress. A list of possible offsets (PDF)—all proposed in earlier budget or deficit-reduction talks—floated around Capitol Hill this week.