HELENA — In the battle over health care reform, U.S. Rep. Denny Rehberg and his fellow Republicans in Congress are known mostly for one thing: Saying “no,” again and again, to President Barack Obama’s plan and new law.

They’ve voted several times to repeal it (such as last Wednesday), supported lawsuits to undo it, tried many ways to block its implementation and relentlessly bashed Democrats who supported it.

What may get lost in the political shouting match, however, is that Rehberg and Republicans do have health reform proposals of their own — and have passed bills on the subject.

“These are all pieces that we as a Republican conference wanted to present (in 2009),” Rehberg said in an interview last week. “But (Democrats’) solution was essentially a government solution.”

Yet, at the same time, elements of some of their main proposals —interstate sales of health insurance, allowing businesses to pool together to buy insurance, use of high-risk pools for the hard-to-insure — are included in the 2010 Affordable Care Act (ACA), known by its detractors as “Obamacare.”

The GOP’s health care ideas also are not without opposition. Some question whether the proposals would help substantially reduce health care costs or expand health coverage to the 50 million-plus Americans without it.

The two most prominent Republican reform proposals are to allow more interstate health insurance products and pooling of health insurance customers, and to limit what injured patients and their lawyers can recover in medical malpractice lawsuits.

Republicans in the House passed a medical liability-limit bill in March — only to see it stall in the Democratic-controlled U.S. Senate — and have considered bills on interstate insurance sales.

Rehberg and fellow Republicans say allowing businesses to pool across state lines to buy health insurance and sales of interstate products would increase the options and reduce the cost for health insurance.

They’ve also advanced other ideas, such as letting people take tax deductions for the cost of individually purchased health insurance and encouraging more use of tax-deductible Health Savings Accounts.

When asked why Republicans didn’t pass such measures in the mid-2000s, when they controlled Congress and the presidency, Rehberg says he believes proposals often were blocked in the U.S. Senate, whose rules give the minority considerable power.

Also, Rehberg says the first step now has to be repealing the ACA: “We have to have a starting point. … “the ‘replace’ is putting the puzzle back together.”

The GOP House voted in March to pass HR5, which would impose a national limit of $250,000 on “non-economic damages” in medical malpractice lawsuits. HR5 also would severely restrict punitive damages and allow courts to limit attorney fees in such cases.

The nonpartisan Congressional Budget Office estimated that HR5 would drop health care costs by lowering medical-liability insurance costs —including those paid or subsidized by the federal government.

There is wide debate on how much these limits might lower costs.

Al Smith, executive director of the Montana Trial Lawyers Association, said Montana already has relatively strict limits on malpractice awards, but that its per-capita health care costs are only slightly lower than Wyoming, which has few such limits.

Rehberg, who voted for HR5, says it’s clear the limits would lower costs, and that Democrats and the president have refused to consider them.

“Anything you do to control that cost has to save money,” he said. “We already know for a fact that the cost of (malpractice lawsuits) will be passed on to consumers.”

However, the ACA does include a provision allowing states to conduct pilot projects on malpractice limits. No projects have been funded by Congress.

Current law also allows interstate pooling by similar businesses to buy health coverage, on a small scale. Insurance brokers say it produces some savings, and expanding it would be helpful – but that health care costs are what really drive the cost of insurance.

The ACA has other provisions to encourage pooling among businesses and allow interstate insurance sales.

Yet many health insurers and state insurance regulators oppose interstate sales, saying it could mean a new level of federal licensing and regulation over insurance, and less consumer protection.

“We don’t think it would be in the best interests of either states or consumers,” said Dave Self, senior vice president and chief marketing officer for PacificSource, an Oregon-based health insurer that recently expanded into Montana and does business in several Northwestern states. “It can be cumbersome to implement state-specific benefit mandates, (but) we believe the benefits outweigh the challenges.”

Some Republicans in Congress have supported the idea for years. Last year, Rep. Marsha Blackburn, R-Tenn., introduced HR371, and Rehberg is a co-sponsor. The bill, which would allow a health insurer licensed in one state to sell its policies in other states, has been parked in a committee for more than a year in the GOP-controlled House.

Christina Goe, general counsel for state Insurance Commissioner Monica Lindeen, says her office worries that such a law would restrict how the Montana commissioner could help consumers if they buy and later have problems with the out-of-state policy.

Rehberg says insurers and state commissioners have always opposed such laws.

“They want to limit the ability of an individual like myself to go over and buy a better product in Washington state, or in a bigger pool,” he said. “Montana consumers buy products from out-of- state companies every day if they can get the right product and the right price from a good company. Why not health insurance?”

Rehberg also says he’d like to expand the use of subsidized high-risk pools for people who have trouble getting health coverage because of pre-existing health conditions.

The ACA did just that, providing funding to cover several hundred additional high-risk people in Montana. Rehberg, however, notes that Montana already had a high-risk pool — the Montana Comprehensive Health Association — and could have expanded it and subsidized rates for more people without a new federal plan.

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