At National Review Online, James Capretta spells out how a Republican controlled government could repeal health reform, even without 60 votes in the Senate. It relies on the budget reconciliation process, which he explains (so I won’t). The key part of the piece is relatively brief,
Senator Conrad’s contention that Obamacare shouldn’t be repealed in reconciliation because Obamacare reduces, not increases, the budget deficit doesn’t stand up to scrutiny. […]
All the House and Senate would have to do is couple repeal with some strategic cuts in spending (including, perhaps, retention of some cuts that were enacted in Obamacare itself). The total package would then be estimated to cut the deficit and therefore fall well within the normal boundaries of a reconciliation bill.
I am not enough of an expert on the rules of the Senate to independently verify the soundness of Capretta’s proposed strategy. [Later — Turns out, there is an incorrect implication in it.] I’m willing to believe it would hold up with the parliamentarian. If so, there is a lot of health care and health care reform riding on the 2012 election.
What I do know is that repeal will be a campaign issue well before it is a legislative possibility. As such, you will likely hear that both implementing and repealing the law will be budget busting moves.
My bet: in hindsight, either side will be able to claim they were right. If health reform is fully implemented, health care spending will still rise more quickly than inflation, the economy, or wages. That won’t necessarily be due to the law–it was expected to rise at least that rapidly anyway–but that won’t stop people from claiming it is.
And, if health reform is repealed, health care spending will just as surely rise at a rate faster than inflation, the economy, or wages. We won’t know for sure whether it would have really risen more slowly with reform, but that won’t stop people from claiming that it would have.
My other prediction is that if reform is repealed by reconciliation and replaced with something else, we’ll see that something else repealed by reconciliation too. In other words, there’s no reason to expect one round of repeal and replace. Once we start down that road, there’s no end to it.
The US has been at health reform for a century. Another is not unthinkable.