Reporting from Washington — As they campaign to recapture Congress, Republicans are vowing to repeal President Obama's new healthcare law and relieve Americans from rising insurance premiums and bigger government.
But some conservatives acknowledge that the healthcare program offered by party leaders is largely unchanged from the proposals the GOP pushed when it held majorities from 2000 to 2006. During that period, insurance premiums skyrocketed, businesses reduced benefits and the number of Americans without health insurance rose.
"I'd be the first to admit to you that Republicans did not address healthcare the way they should have," said Rep. Charles Boustany Jr. (R-La.), a surgeon who was elected in 2004.
While there is some disagreement, Republicans have largely coalesced around an approach that builds on basic pillars of GOP healthcare policy: loosen state regulation of insurance markets to allow insurers to sell policies across state lines; put new limits on medical malpractice lawsuits; and expand so-called high-risk pools to provide insurance to sick Americans who are denied coverage.
"We will approach it in smaller bites. That is the wiser course," said Minnesota Rep. John Kline, who is in line to chair the Education and Labor Committee in a Republican-controlled House.
Kline and other Republicans pledge to protect a healthcare system they say is threatened by the new law.
"One of our No. 1 priorities needs to be to preserve the good things we have now," said Rep. Wally Herger of Chico, who would chair the House Ways and Means health subcommittee if Republicans take the House.
But as costs continue to climb and the ranks of uninsured swell, the nonpartisan Congressional Budget Office last year estimated that the House Republican plan would leave 52 million people without insurance in 2019, compared with 50 million today.
"The problem is that if you want to insure more people, you have to put more money on the table," said Gail Wilensky, who ran the Medicare and Medicaid programs under President George H.W. Bush.
Even on the cost front, which GOP leaders say is their top priority, it is unclear that the proposals will make much of a dent in the nation's skyrocketing healthcare tab.
"They are fine proposals. But they don't add up to a lot of money saved," said Joe Antos, a scholar at the conservative American Enterprise Institute. "There are not a lot of new ideas floating around."
Antos supports a more ambitious program championed by Rep. Paul D. Ryan (R-Wis.) and a handful of other GOP lawmakers that would replace employer-provided healthcare and traditional Medicare with credits and cash that Americans could use to shop for their own health plans.
Thus far, Republican leaders have rejected such a plan, which would pose major political challenges at a time when most Americans say they like employer-provided coverage and Medicare.
Utah Sen. Orrin G. Hatch, a six-term Republican in line to chair the Finance Committee in a GOP Senate, said Republicans could now craft a broadly popular program.
"We could come up with a healthcare system that the American people would not only be proud of, but would actually love," he said. "We've never had a real conservative majority."
During the period from President George W. Bush's election in 2000 to the end of GOP congressional majorities in 2006, Republicans failed to pass major healthcare changes despite evidence of an escalating crisis.
American workers saw their health insurance premiums jump 78%, as the average price tag for an employer-provided family health plan surged to $11,480 a year, according to a survey of employer health benefits by the nonprofit Kaiser Family Foundation and the Health Research & Educational Trust.
That took a toll on businesses and employees. In 2000, 69% of employers provided their workers with health benefits, the Kaiser surveys found. In 2006, 61% were offering health insurance.
By the time Republicans lost control of Congress, an estimated 43.6 million Americans did not have health insurance, up from 41.3 million six years before.
Republicans did pass a historic expansion of Medicare, helping millions of seniors get prescriptions. But rather than scale back government-run healthcare as they now promise, Republicans presided over a 74% surge in overall spending on Medicare, according to the program's trustees.