Austin Frakt makes a good point that opponents of health care might not repeal the bill, but could weaken it:
What I think is more likely than repeal, though by no means certain or even highly probable, is an erosion of the low-income subsidies in real terms, perhaps tied to a change in the minimum level of coverage required. A Republican congress and president might pass such changes along with a tax cut. It is very likely that Republican candidates will campaign on it.
I could see the whole thing being spun as middle class assistance: options for cheaper insurance and a lower tax bill, albeit with subsidies for the poor that don’t keep up. Since the poor aren’t a big constituency this strikes me as at least plausible.
Another wrinkle that could make this work is a weaker mandate that includes exemptions when the premium-to-income ratio is above a threshold. Put it all together and you’ve got a gradual erosion of health reform: worse insurance, less low-income assistance, fewer individuals covered, a weaker mandate.
I agree that is is more plausible than repealing the bill. I still think it’s unlikely, however. Can you imagine the effort it would take to do this? I think the American public will be sick to death of health care reform. The economy is still not good. Terrorism keeps popping up. We’re still in two wars. And so on.
Moreover, any new bills would still require 60 votes in the Senate. While it’s hard to find 60 votes to support reform, it would be just as hard right now to find 60 votes to weaken it in the future. A lot of the Senators like reform and wish it went even further. Just as it’s hard to replace conservative Democrats in conservative states with more progressive Senators, it would be hard to replace progressive Democrats with more conservative Senators in progressive states. Many of those Senators won’t come up for election for years. They won’t have the numbers – not for some time.