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Affordable Care Act

Q&A: As Obama Health Law Survives, GOP Split Over Next Move

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http://boehner.house.gov/

Having lost their latest war against President Barack Obama's health care overhaul, Republicans must decide how to wage battles that could fan the issue for the 2016 elections.

Last month's Supreme Court decision upholding the statute's federal subsidies, which help millions of Americans afford health care, shattered the GOP's best chance of forcing Obama to accept a weakening of his prized law. Without that leverage, Obama would likely veto any major changes they'd send him.

They could, however, try sending him veto-bait legislation designed to show voters how they'd reshape the nation's health care system — if only Republicans could agree on what to do.

With the GOP-run Congress back from a July 4 break, here's a look at their problematic path:

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Q: REPUBLICANS SAY THEY WANT TO REPEAL AND REPLACE THE HEALTH CARE LAW, BUT HOW WOULD THEY REVAMP IT?

A: The House has voted over 50 times to repeal all or part of the law. Yet five years after enactment, Republicans have yet to rally behind a replacement plan.

Several GOP lawmakers have introduced bills or vaguely described what they'd prefer. Details vary, but Republicans generally want to weaken federal coverage requirements, such as which procedures must be insured, and give more flexibility to the states. Many also want to cancel the law's requirements that people get policies and that many employers offer coverage to workers — moves Democrats say would wreak havoc on insurance markets and leave millions without coverage.

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Q: WHAT'S PREVENTING REPUBLICANS FROM COALESCING BEHIND ONE PLAN?

A: Republican lawmakers face varying political imperatives back home.

Some from strong GOP areas need to worry about satisfying deeply conservative voters, who despise Obama's law. Others from closely divided states don't want to abolish parts of the statute — like its subsidies and other consumer safeguards — that help millions of voters.

And that's just the congressional races. The campaign for the GOP presidential nomination adds more complications.

Several hopefuls are senators and might use the health care issue to distinguish themselves from competitors — perhaps making them less inclined to heed party leaders and back a consensus plan. And the eventual GOP presidential candidate will likely offer his or her own plan, leaving some congressional Republicans wondering why they'd push a proposal their own nominee's would overshadow.

Republicans also face thorny decisions about their proposals. How far would the measure go? How much would it cost, and crucially, how would they pay for it?

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Q: CAN REPUBLICANS EVEN GET A REPLACEMENT TO OBAMA'S DESK?

A: That's unclear. House Speaker John Boehner, R-Ohio, would not commit recently to holding a House vote this year on a GOP alternative.

The Senate presents an additional problem. Republicans have 54 of the chamber's 100 seats, and Democrats might kill any GOP plan by filibuster — procedural delays that can derail legislation lacking 60 votes.

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Q: CAN REPUBLICANS GET AROUND THAT?

A: Potentially.

The Senate can use a streamlined process called reconciliation that prevents filibusters. It would let Republicans pass something with a simple majority of Senate votes.