While Connecticut lawmakers attended a birthday party with cake and testimonials, Congressional Republicans used Wednesday’s one-year anniversary of the health care reform law to tout their continued attacks on the measure–from full repeal to targeted defunding efforts.

“In the coming weeks, you’ll see more votes and more hearings in the House to take this law apart, step by step,” House Speaker John Boehner, R-Ohio, said in a video statement today. “That includes repealing the law’s mandatory spending slush funds.”

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Murphy, Courtney, Larson and Blumenthal listen to Mandy McCullough describe worrying about insurance coverage limits for her son Kyle, 8, who has hemophilia

But one thing Boehner and other GOP lawmakers didn’t mention: Since taking power in January, Republican leaders have passed two stop-gap spending bills that include funding for the law’s continued implementation.

The disconnect between rhetoric and reality highlights a GOP conundrum on health reform. Even as the party continues to attack the law, their options for unraveling it are limited. And pushing the issue too far is fraught with risk, despite the political resonance such a move would carry among conservative voters.

“It raises some interesting questions about who precisely is being held hostage here,” said Joseph Antos, a health care expert at the American Enterprise Institute, a right-leaning Washington think tank.

Take, for example, Boehner’s pledge on Wednesday to go after health reform’s “mandatory slush fund.” That’s a reference to legislation proposed by Rep. Steve King, R-Iowa, to target $105.5 billion in automatic federal funding included in health reform to carry out the overhaul.

King’s bill is the next battleground for defunding health reform, and Boehner has promised a House vote on it soon.

Members of Connecticut’s congressional delegation warned about the effort to fight the law during Wednesday’s celebration at the state Capitol.

“Make no mistake, that opposition continues,” Sen. Richard Blumenthal, D-Conn., told the crowd. “It will be out there. It is already against us, and it is in the form of trying to nickel and dime health care reform today.”

Because repealing the law is a nonstarter in the Senate, Rep. John Larson, D-1st District, said Republicans will focus on “death by a thousand slashes”–defunding it.

The celebration was sponsored by Health Care for America Now, and was meant to promote both the federal law and SustiNet, a proposal to create a state-run insurance plan that would serve as a public option for Connecticut. In addition to Blumenthal and Larson, the event drew Reps. Joe Courtney and Chris Murphy, Democrats from the 2nd and 5th districts respectively, as well as Gov. Dannel P. Malloy, state Comptroller Kevin Lembo, U.S. Health and Human Services Regional Director Christie Hager, state House Speaker Christopher G. Donovan, and a crowd of supporters.

Malloy, who has been chided by SustiNet supporters for not embracing the proposal, emphasized his support for federal reform and contrasted his position with those of other governors who are seeking to have the law overturned in the courts.

“The ferocity in which they would like to dismantle that which has been accomplished is really quite disturbing,” he said. “Quite impressive but quite disturbing at the same time.”

“Be assured that Connecticut will be at the forefront of moving forward the implementation of this legislation,” Malloy added.

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Donovan, Murphy and Blumenthal cut and distribute birthday cake for the health reform law’s first anniversary

Several state residents spoke of how they benefited from the reform law. Mandy McCullough of Simsbury, whose sons have hemophilia and rely on medication that costs thousands of dollars a month, described the relief of no longer having to worry about her children reaching lifetime limits on the health benefits they can receive. The law banned lifetime benefit limits in insurance policies.

Thomas Boccaccio of Newington spoke of fighting with his insurance company while his wife fought adrenal cancer. “They will do whatever they can to steal whatever they can from us,” he said. “Thank god for this act. And if it’s not worth fighting for, than nothing is worth fighting for.”

Murphy pointed to some of the first provisions of the law to take effect, including a policy allowing young adults to remain on their parents’ insurance to age 26, a cut in the amount seniors must pay for prescription drugs under the Medicare “donut hole,” and tax credits for small businesses that provide coverage to their workers. That will keep people from supporting the Republican plan to repeal the law, he said.

“The most important result of this bill is that people’s lives are changed,” he said.

In Washington, House Republicans have so far only targeted new discretionary spending that is needed to implement health reform. The GOP’s spending bill for fiscal year 2011 included nine defunding provisions. Among other things, for example, that bill called for prohibiting the use of federal funds to pay the salaries of the government officials writing health reform regulations or otherwise implementing the law. Another provision would bar the Internal Revenue Service from enforcing the law’s individual mandate.

King’s bill would go further by targeting not just future implementation money, but “reaching back,” as he put it, into a pot of automatic funds already at the disposal of the Department of Health and Human Services. But King is not satisfied with just a straight up-or-down vote on his bill.

He and others want it to be included in any final 2011 spending bill–a move that GOP leaders have, so far, blocked. That 2011 funding legislation died upon arrival in the Senate earlier this year, in part because Senate Democrats objected to the nine defunding provisions.

Now, Republicans are divided over how to move forward. Conservatives like King want to use all their leverage to attack health reform. That means insisting that King’s bill and other defunding provisions are included in any “must-pass” spending bill that will keep the federal government running for the rest of this fiscal year.

Last week, King and 53 other House Republicans voted against a three-week stop-gap funding measure, in part because it failed to include any defunding mechanisms. They want to force a fight, first with Senate Democrats, and then, if possible, with President Barack Obama.

“If we attached my amendment blocking ObamaCare’s $105.5 billion in automatic funding to the continuing resolution, President Obama would face a choice: side with the American people and agree to defund ObamaCare, or unilaterally shut down the government as leverage to protect his namesake law,” King wrote in an op-ed in his home-state paper today.

Boehner’s spokesman did not respond to a question about how hard he would push on defunding as House and Senate leaders try to reach a deal on overall 2011 spending.

But Antos said so far, indications are that GOP leaders will exclude those provisions from the broader spending deal. Instead, they’ll likely opt for “a stand-alone resolution that defunds [health reform] and that will simply be tossed on to Harry Reid’s trash pile,” he said, referring to Senate Majority Leader Harry Reid, D-Nev.

There’s little question that a stand-alone bill would go nowhere in the Senate. And even a must-pass spending bill would face fierce opposition among Senate Democrats if included provisions to block funding for health reform.

The prospect of a government shut-down over protecting federal money for health reform could, at the very least, put Senate Democrats and Obama in a politically uncomfortable spot, King argues.

Blumenthal said Obama will serve as a “backstop on preserving health care rights and preventing a retreat to a time when insurance companies really made the rules.”

Antos said that both sides have much to fear in a government shutdown over health reform funding. But Republicans like Boehner remember how the shut-down unfolded last time, with a political backlash aimed at the GOP.

“With the new crop of House members, many of them don’t see anything wrong with shutting down the government,” he said. “They haven’t had the personal experience to know what that means… But the ones who lived through the shut-down 10 years ago realized that didn’t play well at all.”

“The real question for Republicans is, what strategy do they want to try and what risks are they willing to take?” Antos said. His prediction: despite all the GOP rhetoric Wednesday about ramping up their attacks on health reform, Republicans won’t push it to the brink.

“After the presidential election, they’ll try again,” he said.

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