Can a President Romney Really Get Rid of the Affordable Care Act?

If Mitt Romney becomes our next President, can he really do what he says he will in terms of repealing and replacing the Affordable Care Act?

In short, probably not.

As Timothy Jost writes in yesterday's online Health Affairs.com:

Summing Up The Situation If Romney Wins

All of this is to say that the election of a president opposed to implementation of the ACA would create a quite messy situation.  Some provisions of the law—in particular many of the provisions governing insurers—would remain in place and could not easily be repealed.  Other provisions could be repealed through reconciliation, but not immediately and not without a battle in Congress.  If the Democrats hold the Senate, even this would not be possible.

The 2014 deadline for implementation of the next round of reforms, including the issuance of premium tax credits, the exchanges, and the Medicaid expansions, would continue to loom as mandatory until Congress took action.  The administration could rescind or amend existing rules, but it would take time and there would be limits on what could be accomplished.  The administration could try to ignore provisions of the law or delay their implementation, but would almost certainly face litigation, which would once again embroil the courts in ACA implementation.  The prospect of lawsuits brought by states is quite conceivable.

In the end, any dramatic change in health policy will probably have to be bipartisan.  Bipartisanship has not been much in evidence lately, but it is unlikely that we will soon again face the situation that got the ACA enacted—the total domination of both houses of Congress and the presidency by one party.  Until and unless that happens again, the opportunities for change in the ACA are real, but limited.

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With the likelihood of a clean sweep by the Republican Party this November almost nil, Jost's point that it will be a slow, difficult process rings true. For those of us who strongly support health care reform and even those who generally support the highly imperfect Affordable Care Act, the reform should mostly stay intact. The longer it does so, the harder it will be to remove. Advocates will look at it as a root system of a large tree growing and taking firm hold, while opponents will view it as a virus continuing to spread with no cure-all available. 

Read the entire article here.