“If Obamacare goes away, it doesn’t mean that the problem of how you deliver health care affordably and get good access goes away,” Representative Greg Walden, Republican of Oregon, said. “Those are the issues that are back before us.” Republicans say they will have to make good on their pledge to replace the health care law if the Supreme Court strikes down any significant parts of it. They remain optimistic about the possibility of a court victory, even as they begin thinking more seriously about what would follow. “Our wheels are beginning to turn,” said Representative Fred Upton, Republican of Michigan and chairman of the House Energy and Commerce Committee, which would have a large role in developing Republican alternatives to the Obama health care law. Beyond some familiar ideas and slogans about “patient-centered health care,” the Republicans concede that they have far to go to come up with a comprehensive policy to fill the gap that could be left by a Supreme Court ruling this summer. Their approach is likely to set aside universal health insurance coverage as the main objective. Instead, they would focus on lowering costs as “the overriding goal,” said Senator John Barrasso, Republican of Wyoming, a medical doctor and party spokesman on health issues. “If you get the costs down, then you get more people with coverage,” Mr. Barrasso said. Republicans are dusting off proposals that date back more than a decade: allowing individuals to buy health insurance across state lines, helping small businesses band together to buy insurance, offering generous tax deductions for the purchase of individual policies, expanding tax-favored health savings accounts and reining in medical malpractice suits. Many of these ideas were included in a package offered by Republicans in November 2009 as an alternative to legislation pushed through the House by Democrats. The Congressional Budget Office found that the Republican proposal would have reduced health insurance premiums by 5 percent to 10 percent, compared with what they would otherwise have been. The budget office said that the Republican proposal, offered by Representative John A. Boehner of Ohio, who is now the House speaker, would have provided coverage to 3 million people, leaving 52 million uninsured. By contrast, the budget office estimates that the existing law will cover about 30 million people, leaving 26 million uninsured. Emily S. Porter, a policy adviser to Mr. Boehner, said the House had voted 26 times to “repeal, de-fund or dismantle” the new health care law. A ruling striking down the health law could pose future political problems for Republicans if Americans are still unable to find affordable health insurance or if policies provide inadequate coverage. Republican lawmakers with experience on health care issues acknowledge that they will have to take action should the health law fall, and planning for the next steps has kicked into high gear. Several Republicans, like Representatives Michael C. Burgess of Texas and Tom Price of Georgia, are developing comprehensive alternatives, and they wish that more of their Republican colleagues would join these efforts. “The status quo is unacceptable,” said Mr. Price, an orthopedic surgeon who is chairman of the House Republican Policy Committee. “Everybody agrees on that.” In the spring issue of the journal National Affairs, two conservative policy analysts, James C. Capretta and Robert E. Moffit, lay out a road map in an article titled “How to Replace Obamacare.” “Despite the widespread public antipathy toward the new health care law,” they write, “simply reverting to the pre-Obamacare status quo would be viewed by many Americans, perhaps even most, as unacceptable.” Mr. Upton said Republicans were already looking at which parts of the Affordable Care Act they would preserve. The “easiest one,” he said, is the provision that allows young people up to the age of 26 to remain on their parents’ insurance. That option has proved popular and effective. A more difficult question for Republicans is what to do about another popular provision of the law, which will prohibit insurers from denying coverage or charging higher premiums to people who are sick or have disabilities. Republicans favor incentives rather than a mandate to carry insurance, and they acknowledge that rates could soar unless they find ways to keep healthy people in the insurance pool. “We’d have to get that balance right,” Mr. Upton said.
