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Republicans devise strategy on Obamacare

WASHINGTON — The newly installed Republican majority has no intention of stopping its battle against President Obama’s health care law. But recognizing that any attempts to repeal “Obamacare” will end in a veto, the party is devising a strategy that relies on ripping out key parts.

The plan reflects the realities of a Democratic president who can veto legislation, growing support for the expansion of Medicaid benefits, and the potential fallout for Republicans in Democrat-leaning states where a repeal vote could cost them the next election.

“There are pieces of [Obamacare] that are deeply unpopular with the American people,” said Mitch McConnell, the incoming Senate Majority Leader at a Wednesday press conference in his homestate of Kentucky. “We will be addressing that issue in a variety of different ways.”

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He mentioned cutting a tax on medical devices, changing employer requirements on insurance by increasing the definition of a full-time worker from 30 to 40 hours per week, and eliminating rules that most Americans obtain insurance or face a penalty, known as the individual mandate.

McConnell said last week on Fox News that he would “put the Senate Democrats in the position of voting on the most unpopular parts of the law, and see if we can put it on the president’s desk and make him take real ownership of this highly destructive Obamacare.”

President Obama, in his Wednesday press conference, emphasized certain “lines I am going to draw” such as repealing the law and eliminating the individual mandate.

But he left open the possibility of changes to his signature legislative achievement.

“The law is working but that doesn’t mean it can’t be improved,” he said.

The Senate may still vote to repeal the law, a largely symbolic gesture the Republican-led House has undertaken — either on the full law or aspects of it —more than 50 times.

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Don Stewart, a McConnell spokesman, said the senator also supports reconciliation, a special procedure that allows legislation to pass without the minority’s chance to block it. The move would go after budget items such as tax credits used to buy insurance off the healthcare exchanges.

“After a lot of storm and fury in the first four to six months, it will end up [with] what are the extraneous things that the Obama administration and Senate Democrats are willing to let go of in order to move on and then that’s the end?” said John McDonough, a Harvard public health professor who helped craft the Massachusetts and federal healthcare laws.

The Affordable Care Act, signed into law in 2010, aims to give more Americans access to quality health insurance and reduce overall healthcare spending. More than 7 million people have enrolled.

But the law has faced persistent Republican attacks and setbacks, including a meltdown of the website used to sign up for insurance.

The GOP may find support in their effort to repeal the law’s medical device tax, which Democrats in the Massachusetts delegation already disliked due to it costs to Bay State manufacturers. The Pioneer Institute, a conservative research organization based in Boston, has estimated the tax would cost Massachusetts’ biggest companies more than $400 million a year. Both parties also could find common ground on the Independent Payment Advisory Board, which is intended to hold down Medicare costs but has caused concerns about its rigidity and authority.

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“It’s the antithesis of the Christmas tree,” McDonough said, in reference to a procedure where senators stack unrelated amendments onto a bill to get them passed. “It’s how many things they can hang on the tree so they go down the drain.”

Republicans, including Susan Collins of Maine and John Barrasso of Wyoming, have emphasized the need to move past attempts at repeal.

“I want to put things on [Obama’s] desk that he would actually give true consideration to signing, because they’re good for our economy, they’ll get people working again and they’ll help move the country forward,” Barrasso recently told WPBI radio.

The public also appears more inclined to fix the law. A Kaiser Family Foundation poll this October found 64 percent of those surveyed want lawmakers to improve the law compared to 33 that hope it gets repealed.

Republicans see a political benefit to battling provisions that are unpopular among the GOP but embraced by the White House, such as the individual mandate. That, in turn, could put pressure on some moderate or conservative Democrats who come from conservative states where the mandate is unpopular.

“These types of things put Democrats in a much bigger bind,” said Michael Tanner, senior fellow at the Cato Institute, a libertarian think-tank in Washington.

But Republicans also face a challenge winnowing core elements of the law without a viable replacement. Few GOP candidates focused on healthcare options during the election or offered much in the way of alternatives.

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“McConnell is going to send test votes on a couple of discrete items but nothing that goes to the heart of the matter…only because there’s not an alternative,” said Jim Manley, a former spokesman to outgoing Senate Majority Leader Harry Reid.

Republicans also must deal with a potential rift in the party between conservatives who demand a full-throttle attack on the healthcare law, and those who prefer a more tempered response due to the popularity of certain provisions in their home states.

Texas Senator Ted Cruz, a potential presidential candidate who spent the election propping up conservative candidates from Alaska to Kansas, penned a recent op-ed in USA Today stressing the need to “repeal legislation (forcing an Obamacare veto) and then pass bill after bill to mitigate the harms of Obamacare.”

A number of Republican governors have embraced an expansion of Medicaid, a prime intent of the law. But the election does not appear to have had much effect in adding to the 27 states that chose to expand their programs.

This means the battle over Obamacare will live on, analysts say, albeit with a shifted course.

“There’s going to be something called the Affordable Care Act that is going to be around for some time to come and probably permanent,” said Cato’s Tanner. “But you may see it whittled away in the future.”


Jessica Meyers can be reached at jessica.meyers@globe.com. Follow her on Twitter @jessicameyers.