Congressional Republicans hoping to pare back the health care law between now and 2012 are going to face a lot of challenges. Thanks to Obama's veto power, outright repeal is off the table. An aggressive defunding effort, while appealing in some ways, could lead to politically difficult showdowns over the budget. And while there may be some opportunities to make it more difficult for the Department of Health and Human Services to implement the law, a large portion of the implementation battle will take place at the state level.
But Congressional Republicans ran against the health care overhaul, which means they'll have to pursue it somehow. We'll probably see a symbolic vote to overturn it—perhaps several. But the most effective and practical way to contain the law between now and 2012 will probably be to go after single sections, as the David Gratzer and Paul Howard of the Manhattan Institute suggest here and here. There are a host of controversial provisions that could be modified or wiped out—starting with the 1099 reporting requirement, which even President Obama has said is probably too burdensome on business.
As Howard says, the chipping-away strategy will probably work best if the party can find some bipartisan support. I'm typically wary of kneejerk bipartisanship, but he's right in this case. The politics of the health care law are such that a few Democrats might be willing to join Republicans in taking out selected parts of the law. Sen. Max Baucus, who oversaw a lot of the early negotiations over the law, is already indicating that he may be open to making changes in the legislation. And Republicans are reportedly on the hunt for other potential Democratic allies.
The upside of a strategy like this is that it stands a chance to result in actual (if small) changes to the law. It's a path toward opposing the legislation that doesn't rely mostly on erecting procedural barriers, as defunding strategies and state-led efforts to block or slow implementation would. The downside, at least for those who'd like to scrap the law entirely, is that it could reduce the urgency to repeal the law. Relying on an ongoing series of small tweaks, especially bipartisan tweaks, risks implying that the law doesn't eventually need to be fully overturned.
My take on how the recent elections will shape the coming health care policy battles here.