Yes, if Mitt Romney wins the White House and Republicans retake the Senate, he could shred most of President Barack Obama's health care law. But it won' be easy or quick.
Any realistic effort to repeal the Affordable Care Act is sure to get jumbled together with lots of other issues.
And that's because Republicans have to first pass a budget. It's the only way than can invoke special Senate rules that allow legislation to pass with just a simple majority vote - instead of the 60 votes needed in the 100-member Senate to beat a filibuster.
Passing a budget requires answering a raft of questions unrelated to the relatively simple idea of repeal. How much to cut the deficit? Should Medicare be overhauled and Medicaid bear sharp cuts?
The first step is to pass a budget resolution - a nonbinding outline of budget goals. A budget resolution sets the terms for follow-up legislation that's called a reconciliation bill in Washington-speak..
Two years ago, Democrats used a reconciliation bill to finalize the health care law with a 56-43, party-line vote in the Senate.
Republicans have a problem in that there's a lot more on their agenda than just repealing the health care law, and it's all going to have to be crammed into a budget resolution and follow-up reconciliation bill, too.
"They're going to want to use that budget resolution to set up a tax bill, they're going to want to do other deficit reduction," said Hazen Marshall, a GOP lobbyist and the Senate Budget Committee's top aide in 2001 and 2003 when reconciliation bills were used to push former President George W. Bush's tax cuts through Congress.
"So I would think it's just going to take some time to get everybody on the same page as to what the budget resolution's going to look like," Marshall said.
In 2001, when Republicans set about the relatively simple task of cutting taxes in an era of unprecedented budget surpluses, it took them until Memorial Day to pass the legislation. What Republicans would confront next year is far more difficult.
"It's not that it's not doable. It absolutely is doable," said a senior House GOP budget aide. "It's just going to take a lot longer than everybody wants it to. And people aren't anticipating the pain of each step to get to that point." The aide spoke on condition of anonymity because he wasn't authorized to speak on the record.
Republicans currently hold 47 Senate seats. If they take control of the Senate, it's not likely to be by more than 1 to 4 votes, well short of 60. That would put lots of leverage in the hands of Senate GOP moderates like Susan Collins of Maine and Scott Brown of Massachusetts, should he win re-election bid.
Keith Hennessey, a former GOP Senate and White House official, says that if Republicans follow past practice, they'll try to forge a center-right agreement that includes spending cuts but no tax increases. But he noted that the willingness of some Republicans to embrace tax increases could complicate matters.
"You look at the Republicans and you see that there's going to be a spectrum on how deep they're going to be willing to cut various things," said Hennessey, currently a research fellow at Stanford University. "The question is just how far toward the Ryan plan can you get the moderate Republicans."
On the other hand, combining the repeal of Obama's health care law with other GOP priorities gives lawmakers who are not part of the leadership plenty of incentive to vote for the package.
"When elections are about certain policies and are defined on that, you've got momentum to do those things," said House GOP Whip Kevin McCarthy of California.
A simple-majority reconciliation bill could certainly cover the health care law's tax increases - including the penalties used to enforce the individual mandate.
Republicans, however, could not use the filibuster-proof budget process to repeal provisions in the health care that don't have a direct impact on the government's balance sheet. For example, it still would likely take 60 Senate votes to repeal the law's requirement that insurance companies cover people with pre-existing conditions.
Experts say leaving the insurance reforms intact on their own is economically unsustainable because the ratio of sick to healthy people in the plans would be out of balance.
"If you were to remove everything else in reconciliation and be left with the insurance provisions, you have something that everybody recognizes is unworkable," said former Congressional Budget Office Director Douglas Holtz-Eakin. "I think if you take enough out, the rest probably has to go."
(WBEN) Buffalo- The latest poll from Siena College says only one in five voters in New York State think Pres. Obama's Health Care Reform law will increase health care access, and only one in eight thinks it will reduce their costs, but that isn't enough for anyone in the survey to apparantly move away from politics.
Three weeks after the US Supreme Court first ruled that the Health Care reform measure could stand, the Siena survey of 758 registered voters says 53 percent of New Yorkers want it to stand and 37 percent want repeal.
"While few voters (in NYS) think Obamacare will reduce their health care costs or increase their access to health care, a majority of voters still wants to see the law implemented and a majority is more likely to support a candidate who favors implementation,”
-- Siena Pollster Steve Greenberg
The break down of various voting groups however shows a split that seems to mirror the national poltical debate:
- A roughly equal margin of registered Republicans are against the plan, while registerd Democrats support it.
- A majority of Protestant and Jewish voters support the law, but a plurality of Catholic voters want to see the law repealed.
- Voters in non union households barely favor implemention, while union households do so overwhelmingly..
- Independents are split almost down the middle.
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By a 45-28 percent margin voters agree with the recent United State Supreme Court decision on the constitutionality of the Patient Protection and Affordable Care Act – often referred to as Obamacare.
In light of the decision, 53 percent of voters want to see the law fully implemented and 37 percent want to see it repealed, with three-quarters of Democrats favoring implementation and three-quarters of Republicans supporting repeal, according to a new Siena College Research Institute poll of registered voters released today.
Only one in five voters thinks the law will increase health care access and only one in eight thinks it will reduce their costs.
“Overall, a plurality of New Yorkers agree with the Supreme Court’s decision that Obamacare is constitutional and a majority want to now see the law fully implemented rather than repealed,” said Siena pollster Steven Greenberg.
“There is, however, a huge partisan difference as 76 percent of Democrats want to see the law implemented and 75 percent of Republicans want it repealed. Independent voters are nearly evenly divided with 44 percent for implementation and 47 percent for repeal.
“While voters in non-union households barely favor implementation by a 50-41 percent margin, voters in union households favor implementation two-to-one. New York City voters favor implementation by better than two-to-one, while suburban and upstate voters are evenly divided. A majority of Protestant and Jewish voters support implementation but a plurality of Catholic voters want to see the law repealed,” Greenberg said.
Fifty percent of voters believe that if the law is fully implemented their access to quality health care professionals will remain about the same, 27 percent say their access will be decreased and 19 percent think they will have greater access. When it comes to cost of health care if the law is implemented, 44 percent think their health care costs will increase, 38 percent think they will remain about the same and 13 percent say they will decrease.
“A majority of Democrats and independents believe that if Obamacare is fully implemented they will have about the same level of access to health care services they have now. A majority of Republicans think their access will be less. A majority of Republicans and independents say they will pay more for health care if the law is implemented, while a plurality of Democrats think their costs will remain about the same,” Greenberg said.
“Among those voters who favor implementing the law, only 18 percent say it will result in decreased cost and only 30 percent say it will increase their health care access. Among those who favor repeal, two-thirds believe their access will be lessened and 78 percent say their costs will increase.
While few voters think Obamacare will reduce their health care costs or increase their access to health care, a majority of voters still wants to see the law implemented and a majority is more likely to support a candidate who favors implementation,” Greenberg said.
States saying no to 'Obamacare' could see downside
Millions of uninsured people may have to wait until after Election Day to find out if and how they can get coverage through President Barack Obama's health care law.
More than two weeks after the Supreme Court gave the green light to Obama's signature legislative achievement, many governors from both parties said they haven't decided how their states will proceed on two parts under their control: an expansion of Medicaid, expected to extend coverage to roughly 15 million low-income people, and new insurance exchanges, projected to help an additional 15 million or so purchase private insurance.
In some states, such as Colorado, Oklahoma and Wyoming, governors said they're crunching the numbers to determine what's best for their residents. But in other states, including Virginia, Nebraska and Wisconsin, Republican governors said not to expect a decision before Obama and Republican challenger Mitt Romney square off in November.
If Romney wins, the argument goes, he'll work to throw out the health care overhaul, and the issue will be moot.
"I don't think I can look the taxpayers of Virginia in the eye and say I'm going to spend a lot of your money building exchanges that four months from now I may not need," Gov. Bob McDonnell, R-Va., said on the sidelines of the National Governors Association meeting.
Although the high court upheld the requirement that individuals either have insurance or pay a fine, the justices undercut Obama's plan to get almost all Americans insured, ruling that states can opt out of the expansion of Medicaid, the government-run insurance plan. People earning up to 138 percent of the federal poverty level qualify for Medicaid under the health care law, except in states that reject the expansion.
The Obama administration said last week that people won't be fined for not having insurance in states that turn down the expansion, meaning Obama's hard-fought overhaul could fall far short of the 30 million or more uninsured he had hoped would get coverage.
Also left to the governors is what to do about the exchanges - Internet-based markets designed to offer one-stop shopping for insurance - that are also part of law. States are supposed to set up their own exchanges, but if they don't, the federal government will run them instead.
About a half-dozen states have announced plans to forgo the Medicaid expansion and relinquish the massive infusion of federal dollars that would come along with it. All have Republican governors, many of whom argued Medicaid is an underfunded entitlement already weighing down their cash-strapped budgets.
Others faulted the Obama administration for failing to provide the specifics that states need to make an informed decision. That sentiment was echoed in a list of 30 questions about the law that the Republican Governors Association sent Obama last week.
The law picks up the entire cost of covering more people for the first three years, and then drops to 90 percent, with states covering the remaining 10 percent. It's a great deal, proponents argue, especially compared to the current Medicaid rates, wherein Washington pays as little as half of the cost in some states.
But a handful of GOP governors attending the NGA meeting said they suspected a bait-and-switch in which states would agree to the expansion only to see Congress cut some or all of the funds, leaving governors on the hook and potentially bankrupting state budgets.
"At any whim they could just pull the money," Arizona Gov. Jan Brewer told The Associated Press. "So yeah, I'm a little gun-shy."
Wisconsin Gov. Scott Walker, who survived a recall election in June, said in an interview that governors were grumbling among themselves about the federal government's track record on special education. Congress in 1975 pledged to fund 40 percent of the cost of special education, but routinely has fallen far short of that commitment.
The politics are tricky for governors weighing how to proceed. Just one-third of Americans supported the health care overhaul in Associated Press-GfK poll conducted in mid-June. But because federal tax dollars are covering the Medicaid expansion, states that opt out are essentially consigning their residents to subsidize coverage for those in other states.
Also, Alabama, Pennsylvania, Utah and other states that are still weighing their options were among those that sued the federal government in an attempt to have the law overturned. If they were so opposed then, the law's supporters ask, why are they leaving the door open to implementing it now?
Both the Medicaid expansion and the exchanges don't kick in until 2014, meaning states technically have some breathing room before they need to make a final decision. But governors who've agreed to take the expansion accused their more taciturn colleagues of playing election-year politics at the expense of taxpayers.
"It's not only irresponsible, it's disingenuous," Vermont Gov. Peter Shumlin said at a news conference organized by Democratic governors. "To say `I'm going to criticize the plan, but I won't tell you whether I'm taking the loot until after the election,' that's what breeds cynicism in the American people."
Shumlin didn't back down even when reminded that some Democrats too are taking the wait-and-see approach, including Colorado Gov. John Hickenlooper.