Republican Health-Policy Focus Shifts to Abortion Limits

WASHINGTON—With little to show for their efforts to repeal the 2010 health law, Republicans have refocused on trying to defund Planned Parenthood Federation of America and tighten federal abortion restrictions.

The shift has occurred both on Capitol Hill and the campaign trail. In the most recent GOP presidential debate, abortion was a prominent talking point while candidates mentioned the Affordable Care Act only a handful of times. In Congress, Republicans are weighing shutting down the government on Oct. 1 in a bid to defund Planned Parenthood. And both chambers are voting on antiabortion bills this month amid a crush of other issues.

The GOP shift reflects a grudging acknowledgment that repealing the ACA won't happen as long as President Barack Obama is in office. "People are sick and tired of Obamacare," said Grace-Marie Turner, president of the Galen Institute, which wants to limit government involvement in health coverage. "Planned Parenthood is something new and fresh."

Sen. Ted Cruz (R., Texas) and conservative House Republicans led the charge in 2013 to block funding for the health law in a fight that led to a partial government shutdown. Now, Mr. Cruz and his House allies are again trying to use a must-pass spending bill in late September as leverage to try to cut funding for Planned Parenthood. A government shutdown back then didn't actually block funds for the health law, just as a shutdown now wouldn't cut off money for the women's health organization.

Republicans have sought to defund Planned Parenthood since July, when the first of a series of videos released by an antiabortion group showed officials with the group discussing procuring fetal tissue from abortions to provide to third parties for medical research.

Senate Majority Leader Mitch McConnell (R., Ky.) is expected to take the first steps toward setting up a Thursday vote on a spending bill that would seek to cut federal funds for Planned Parenthood, congressional aides said. Democrats are expected to prevent the measure from getting the 60 votes needed to clear a procedural hurdle. At that point, Mr. McConnell would likely move to consider a spending bill that retains Planned Parenthood funding, aides said.

Before that, on Tuesday, the Senate is scheduled to vote on a bill banning abortion after 20 weeks of pregnancy.

The House, which has voted more than 50 times to repeal or undercut parts of the health law, has also recently shifted its focus to antiabortion measures. Last week, the chamber passed a one-year moratorium on Planned Parenthood funding and another antiabortion bill.
Rep. Roger Williams (R., Texas) said that his constituents have urged him to vote against any spending bill that includes funding for the group. "Between my conscience and my district, I won't be voting to fund Planned Parenthood," he said.

But attention to the defunding effort also is exposing tensions within the GOP. While many House Republicans say they would oppose any spending bill that includes funding for Planned Parenthood, other GOP lawmakers say that strategy would spark a public backlash without actually ending the group's federal funding.

Rep. Tom McClintock (R., Calif.) said the latest Planned Parenthood fight was undermining GOP efforts to reduce federal spending. "I'm afraid the question over Planned Parenthood has distracted public attention from that overriding responsibility that we have to put the nation's finances back in order before we bankrupt it," he said in a recent interview.

Republicans' shift away from the health law has come at the same time they have picked up some Democratic allies in their efforts to chip away at some of the health law's least popular provisions. Last week Sen. Martin Heinrich (D., N.M.) backed a measure to repeal a 40% excise tax on generous employer plans.

A Senate bill to repeal a 2.3% tax on medical devices also has bipartisan support, particularly from Democrats whose states are home to medical-device companies. The two measures could get rolled into year-end negotiations between the White House and Congress as potential GOP demands in exchange for raising the federal borrowing limit or increasing spending levels.

Republicans' plans to use reconciliation, a procedural shortcut tied to the budget process, to repeal the health law have faded as GOP leaders have proposed instead using reconciliation to cut funding for Planned Parenthood.

Under reconciliation, a bill can be passed in the Senate with just a simple majority, enabling partisan legislation to reach the president's desk. Most measures need 60 votes to clear procedural hurdles in the Senate, where Republicans hold 54 seats.

Even if Mr. Obama would veto any bills to eliminate Planned Parenthood funding or add new abortion limits, many Republicans want to force him to make that choice. By contrast, the battle lines around the health care law are already clearly drawn, they said.

"The health-care law is fairly clear in people's minds: they know Republicans are against it; they know Barack Obama's for it," said Rep. Trent Franks (R., Ariz.) But the Planned Parenthood debate is "not as well defined," he said.

The health law has faded somewhat as a GOP talking point in part because many candidates are still honing their proposals for what would replace it.

Outlining what they would change means distilling down complicated proposals that are difficult for voters to digest. Opposition to the law is likely to heat up once more candidates reveal their proposals, policy experts said.

Momentum has also slowed in the wake of a Supreme Court ruling that upheld subsidized health insurance for lower-income Americans. The June ruling preserved a centerpiece of the law and was a major blow to critics of the ACA.

The court's decision to uphold subsidies to offset premiums spared Republicans a messy internal debate over how far to go to protect those who would have suddenly lost coverage. Few Republicans have been eager to reopen the discussion over how to replace the health law.