Image: Opponents of health care legislation on eve of vote in March
MICHAEL REYNOLDS  /  EPA FILE
Opponents of Democratic health care legislation protest the bill on Capitol Hill on March 21, 2010.
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msnbc.com
updated 10/18/2010 4:21:47 PM ET 2010-10-18T20:21:47

When West Virginia Senate candidate John Raese delivered a thundering promise to support a “termination and repeal of Obamacare” at a recent campaign event, the crowd went wild. “Boy, do I know the applause lines!” exclaimed the Republican hopeful.

Raese’s Democratic opponent, Gov. Joe Manchin, isn’t all that different from his rival when it comes to the sprawling health care overhaul signed into law by the president earlier this year.

Calling parts of the bill “overreaching,” Manchin has said that some parts of the legislation need to be nixed. "If you can't fix it, repeal the whole thing,” he told FOX News last week.

Repealing — or at least “fixing” — the legislation may be a popular campaign proposal out on the stump. But both political and structural realities of the complex reform passed by Congress earlier this year make a wholesale cancellation of the bill almost impossible. And most of the unpopular parts of the plan, at least for the moment, are here to stay.

Legislative hurdles
It's not surprising that candidates of both parties are highlighting what they perceive to be flaws in the far-reaching overhaul effort. According to a Kaiser Family Foundation poll conducted in early October, only 39 percent of likely voters in the 2012 midterm elections have a favorable opinion of the new bill, compared to 49 percent of likely voters who view it unfavorably.

Problems with the implementation of the bill have also made headlines. In recent months, the Obama administration had to issue dozens of one-year waivers to insurers and other corporations who resisted new rules capping coverage for certain health care plans. As insurers anticipate the coming changes, many have raised their premiums.

But — popular or not — killing the bill is hardly a possibility as long as there's a Democrat in the White House.

Even if Republicans win majorities in the House and Senate, President Barack Obama will retain the power to veto any legislation that crosses his desk, a power he’d certainly exercise if lawmakers tried to substantially modify or revoke the defining legislative victory of his first 18 months in office.

If — as most political observers are now predicting — Republicans win a majority in the House, leaders are likely to introduce legislation early next year that would repeal the existing bill and instead propose a GOP-authored replacement that would allow insurance plans to be sold across state lines, a measure that Republicans say would drive down costs because of increased competition.

But even if that measure passed the House, any controversial changes to the bill would face extremely poor prospects of passage in what's almost certain to be a closely divide Senate.

Julie Barnes, the director of health policy at the Bipartisan Policy Center, says that efforts to change the new system also fail to take into account how much has already been done.

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Although the bill is still in the early stages of implementation, says Barnes, state and local governments have already begun to receive federal grant money to establish new protocols — efforts that they aren’t eager to see go to waste.  “Those are bells that are not going to be unrung,” she said.

More likely, she said, would be congressional elimination of funding for particular programs.

House Republicans are considering using the budget process to starve the Internal Revenue Service or the Department of Health and Human Service of money to administer the plan or enforce tax penalties for those who violate it.

House Speaker John Boehner promised to do just that in a recent interview with The Cincinnati Enquirer. “They’ll get not one dime from us,” he said. “Not a dime. There is no fixing this.”

“That’s really the only thing that is politically possible but in [Congress’s] realm of responsibility,” says Barnes, “Everything else has already been accomplished.”

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What about ‘fixing’ the bill?
West Virginia’s Manchin is not the only Democrat in a tight race who has proposed overhauling the legislation.

In a recent debate, Kentucky Democrat Jack Conway called his proposal to “fix” health care “a stark difference” from his Republican rival’s pledge to repeal the bill. Illinois Democrat Alexi Giannoulias, who is locked in one of the country’s tightest Senate races, uses a similar line on the stump, calling the bill “far from a perfect vehicle” and saying of his GOP opponent Mark Kirk, “He wants to repeal it. I want to reform it.”

Some “fixes” could receive bipartisan support. Republicans are likely to target one particularly unpopular IRS reporting requirement that could add a hefty paperwork burden to many companies.

But health policy experts and congressional aides on both sides of the aisle agree that the core pieces of the bill are so intertwined that it would be almost impossible to remove its most unpopular parts without collapsing the system on which the legislation is premised.

The “individual mandate” — the requirement that almost all Americans purchase insurance or else pay a fine — has been particularly reviled by opponents of the reform bill passed this year. Many Republicans argue that the mandate is unconstitutional, a question currently being explored in the courts.

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“America is a country of choices, not forcing people to buy things that they don’t need,” said Nevada Republican Senate candidate Sharron Angle in a debate against Majority Leader Harry Reid on Thursday.

But the mandate, which serves to spread risk throughout large pools of healthy people unlikely to require costly treatments, is a central portion of the bill that lawmakers negotiated with insurers.

“The object of the law is to prevent acute conditions from happening at the first place,” said Barnes. “The only way to do that is to mandate. Our only hope is to spread risk around so that we can make premiums more affordable.”

Some backers of the legislation argue that, as more components of the health care plan become operational, costs to the consumer will be reduced and enthusiasm for “repeal” will fade.

The most popular provisions — like subsidies to those who cannot afford insurance, small business programs intended to reduce premium costs, and a total ban on insurance companies denying coverage to adults with preexisting conditions — will be in place by 2014.

But opponents of the plan aren’t buying it, saying that the Democratic administration has now become the face of a massive system fraught with inefficiencies.

“They’ve just grabbed ownership of every problem in the health care system,” said one House GOP aide. “Every time you wait an extra hour in a doctor’s waiting room, it’s going to feel like Barack Obama’s fault.”

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