That could significantly heighten uncertainty for healthcare industry stakeholders, most of whom have spent considerable time and effort aligning themselves with healthcare reform and want to see it improved but not reversed.
It's unclear whether House and Senate Republicans would be able to agree on an alternative reform package. Some Republicans favor broad legislation including tax credits to expand coverage, while others have pushed for narrower changes such as allowing insurers to sell plans across state lines. But any GOP repeal-and-replace bill would run the risk of causing millions of Americans who have received health insurance under the ACA to lose their coverage, which is a recipe for political trouble.
It's also expected that any new Senate Republican leader would have a hard time keeping the party's right flank in line. That could make it difficult for GOP leaders to do anything that could be viewed as improving the ACA rather than killing it.
Early on, most observers expect a vote to repeal Obamacare since Republicans repeatedly have promised to do so. But any such legislation to dismantle the law would have to first overcome a Senate filibuster by Democrats, and then would face a certain Obama veto.
After that, observers predict Republicans will try to pick off unpopular provisions of the law that some Democrats also oppose and that provide significant funding for coverage expansions. The most likely targets are the individual and employer mandates, the 2.3% excise tax on medical devices and the health insurance tax.
James Capretta, a visiting fellow at the conservative American Enterprise Institute, predicted Republicans also will focus on addressing the cancellation of health plans that don't comply with ACA coverage requirements.
If Republicans take the standard legislative route, they would need 60 Senate votes to overcome a Democratic filibuster, though they could change the filibuster rules. That's why some observers predict they instead would use the complex budget reconciliation process, which requires only 51 votes.
But Condeluci is skeptical about the reconciliation process. The end result, he said, would almost certainly be a presidential veto—though that could lead to a budget showdown involving a government shutdown. In addition, using reconciliation means that House and Senate Republicans would have to unify around a budget, which has proven difficult for them.
Condeluci thinks a more likely course will be for Republicans to hold a series of votes under standard legislative rules to strike down important provisions of the law, forcing Democrats to go on the record voting against repeal. “The ACA isn't going to change much, even with a Republican Senate,” he said. “The Republicans will work to frame the debate between now and the 2016 elections.”
Follow Paul Demko on Twitter: @MHPDemko
