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The Health Care Repeal Fantasy, Cont'd

Ramesh Ponnuru goes another round on whether Republicans can repeal health care reform. The argument mainly boils down to whether Republicans will need 60 Senate votes:

I think he's wrong about this. Presumably parts of Obamacare could be repealed via reconciliation, just as parts of it were enacted that way; it may not be beyond the wit of man to structure total repeal in a way that qualifies for reconciliation. Also, if Obamacare remains unpopular it does not strike me as impossible that some Democratic senators would reconsider their support. And while 60 Republican senators in 2013 is unlikely, it's not impossible given the way this year's races are going and the heavily Democratic make-up of the Senators up for re-election in 2012.

Gaining 10 Senate seats in one election is extremely hard. Doing it twice in a row is extraordinarily hard. And, as I mentioned, the more you gain, the deeper you reach into blue state territory where you need a real moderate to win. It could happen, but it would probably take a double-dip recession.

Now, could Republicans repeal health care via reconciliation? Here Ponnuru seems to be lacking a detailed understanding of how this works. First, Democrats didn't enact health care reform via reconciliation. They enacted it through normal procedures. They amended it through reconciliation, fiddling with the subsidy levels and the tax base in the Senate bill. The reason they didn't enact a whole plan through reconciliation is that the strict limits on what you can do in a reconciliation bill would have made their plan into swiss cheese. The same would hold true of doing repeal through reconciliation.

The most you could do through reconciliation would be to eliminate tax credits for people who purchase health insurance, and cancel out the funding mechanisms, like the tax on high-cost plans or the Medicare cuts. You could not use reconciliation to repeal the regulatory structure, the health exchanges, and whatnot. So you'd be left with a system that required people to buy insurance but left them with no means to purchase it. And the insurers would be required to offer coverage to everybody at a reasonable rate, but they'd have a huge cost-spiral problem. In other words, you could wreck the system, ruin a lot of people's lives, and infuriate medical providers and insurers, but you couldn't make it into something more appealing to anybody -- except possibly a Republican so vindictive at the passage of the Affordable Care Act that they'd be willing to trash the health care system just to spite Obama's legacy.

I don't think Republicans would be willing to do something quite that destructive. And even if they were, Democrats could just change it right back with 50 Senate votes. It's the 60 vote hurdle that's the real obstacle to doing anything.

I don't think repeal is completely impossible, but it is a long, long shot.