Republicans consider new Obamacare strategy

The Republican mantra on Obamacare—repeal, repeal, repeal—is being questioned from an unexpected quarter.

Some pragmatic conservatives are concerned that continuing what has been the Republican repeal battle cry may be counterproductive come the November elections. But they are facing fierce opposition from the Republican right.

Dean Clancy, a former senior White House health policy official in the George W. Bush administration, said Republicans are in a period where they need to appeal to those who seek repeal while moving toward fixing the ACA's flaws.

“Republicans need to switch to a more nuanced approach without dispiriting their base voters,” he said, adding that the message may need to shift to emphasizing health savings accounts, pushing for more regulatory exceptions for high-deductible plans and individual-mandate penalties and “shrinking the Obamacare footprint.”

“They need to begin saying what they would replace it with without slipping into accepting it,” Clancy said. “If they try to win this year solely on repeal, they won't do as well as they expect.”

Medicaid expansion has become a focal point between candidates making vague calls for “change” while seeking to repeal or “fix” Obamacare.

Indiana's Mike Pence is the latest Republican governor attempting a conservative yet middle-ground approach to Medicaid expansion. Pence wants beneficiaries to contribute to the cost of their care and pay into health savings accounts to make them more cost-conscious consumers. Pence recently presented his case for expanding coverage to an additional 350,000 Indianans to the conservative American Enterprise Institute, but it appears his arguments fell on deaf ears there.

But Grace-Marie Turner, a conservative health policy analyst at the conservative Galen Institute, who calls Medicaid “a terrible, terrible program,” endorsed the Pence proposal. “I'm not in the majority,” she said. “We should think of it as a pilot project. If we're going to transform this program, we need models.”

Follow Andis Robeznieks on Twitter: @MHARobeznieks