The obstacles to reform repeal

If elected, GOP candidates could struggle to fulfill health law pledges

Topics: Health Policy, Market Trends, Strategy, Payer and Regulatory Policy

November 2, 2011

Every GOP presidential candidate has pledged to repeal the federal health reform law, but myriad practical and political obstacles could stymie their plans, the Wall Street Journal reports.

As public support for the health law wanes, Republican presidential candidates have launched into a "lively debate" about how they would repeal it. For example, former Massachusetts Gov. Mitt Romney says he would sign an executive order on his first day in office that would allow states to opt out of the law. On his second day, he would repeal the law through budget reconciliation in the Senate, which requires only 51 votes. Meanwhile, Texas Gov. Rick Perry says he would repeal as much of the law as he could through executive order while leading Congress to fully peel back its provisions.

Legislative limitations
However, various legislative limitations could make enacting any of the candidates' proposals difficult, according to the Journal.

Without a 60-seat majority in the Senate, Republicans could be unable to force a vote on repeal legislation. The Senate's budget reconciliation process is the only way to circumvent the 60-vote requirement, but it only can be used to tackle issues directly related to the budget. According to the Journal, leaving the defunded law on the books would allow Democrats to provide funding for it in the future.

Should Republicans attempt to defund the law though reconciliation, Senate rules would require them to find additional savings to offset the cost of repealing or defunding the law, which the Congressional Budget Office says will reduce the federal deficit.

Meanwhile, early waivers would have little impact on the law's implementation because they are not effective until 2017, Bloomberg Businessweek reports, noting that any effort to move up the effective date likely would fail in a Democratic-controlled Senate.

Patients' political pull
The Journal also notes that Republicans would struggle to avoid cutting popular provisions of the law, such as those prohibiting insurers from denying coverage to people with preexisting conditions.

Because many of the provisions are linked with others, it likely would be difficult to repeal unpopular provisions without repealing or weakening popular ones, the Journal reports (Radnofsky, Journal, 10/29; Armstrong/Jensen, Bloomberg Businessweek, 10/27).


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