Byron York

Everyone knows House Republicans (along with three Democrats) voted on Jan. 19 to repeal Obamacare. But fewer people know what those same House Republicans -- this time, with more than a dozen Democrats -- did on Jan. 20.

By a vote of 253 to 175, the GOP directed key House committees to report on ways to lower healthcare premiums, allow patients to keep their current health plans, increase access to coverage for those with pre-existing conditions, and decrease the price of medical-liability lawsuits. In other words, the committees are beginning work on replacing the House-repealed Obamacare with Republican health policies.

Repeal got a lot of press coverage. Replacement got far less. If they needed any reminding, GOP lawmakers are learning that controlling the levers of power in the House doesn't mean controlling the media narrative on health care.

"Democrats wanted to characterize repeal as draconian, ignoring the fact that we do have very, very positive alternatives," says Rep. David Dreier, chairman of the House Rules Committee. "It's been difficult for us to get that (message) out there. We said repeal and replace, and we're in the process of replacing."

House Republicans are pursuing a three-part strategy. Part one was repeal; they promised to do it, and they did it. Part two is replace, which in coming months will involve House votes on a series of GOP healthcare measures. And part three -- because full repeal can't win in the Senate -- is another series of votes on measures to repeal individual parts of Obamacare. The net result will be that Republicans gradually push more and more House Democrats -- and perhaps some in the Senate -- away from an all-or-nothing defense of Obamacare.

When Democrats passed the national healthcare bill, many admitted that they didn't like this or that part, or that the bill as a whole wasn't "perfect." But after Obamacare became law, they balked at changing even the smallest part. For example, there is widespread agreement that the so-called 1099 provision -- the requirement that requires businesses to file zillions of new Internal Revenue Service forms -- is extremely burdensome. But when Republicans tried to kill the provision last year, Senate Majority Leader Harry Reid made sure that it didn't happen.

Now, after voters gave the GOP control of the House and a stronger voice in the Senate, things are different. Democrats are talking openly about changing Obamacare -- just as long as the changes stop short of full repeal. "Let us modify the healthcare law in a bipartisan way," House Assistant Minority Leader James Clyburn told Fox News on Jan. 17. "But this whole stuff of repeal and throwing it out and starting all over -- that's not going to happen."

Obamacare is filled with vulnerable provisions. In addition to the 1099, there's the individual mandate (which is also being challenged in court), cuts to Medicare and the long-term-care measure called the Community Living Assistance Services and Supports Act, better known as the CLASS Act. During the Senate's Obamacare debate in December 2009, some Democrats voiced reservations about each of those provisions.

"Just look at the ones who made noise during the original debate," says a well-connected GOP Senate source. "Claire McCaskill, Ben Nelson, Kent Conrad -- Conrad called the CLASS Act a Ponzi scheme, but he voted for the whole bill that included it. How would he vote on a separate bill to repeal it?"

We'll probably find out. In the next year and a half, Senate Democrats, including some who are facing tough re-election fights in 2012, could have a chance to vote again on the most troublesome parts of Obamacare. With 47 Republican senators, the GOP would need just four Democrats to reach majority support for repealing significant chunks of the healthcare law.

If that happens, Senate Democrats, who at this moment are railing against Republican filibusters, would have to resort to -- you guessed it -- a filibuster to stop repeal of any part of Obamacare. Even if they do, Republicans believe they might muster 60 votes to win the day. And if key parts of Obamacare fall, it's not clear whether the whole structure can remain standing.

As those fights go on, House Republicans, with some Democratic help, will pass new measures to address the healthcare problem piece by piece. Some will be attractive to Senate Democrats facing re-election. "A lot of them come from states that are sympathetic to the message we heard last Nov. 2," says Dreier. "So in light of that, we're not going to give up on this."


Byron York

Byron York, chief political correspondent for The Washington Examiner