Over the course of this year's midterm campaign, Republicans ran endless ads against the Affordable Care Act, the health care law better known as Obamacare. In weeks leading up to the vote, it was the top Republican ad issue for Senate campaigns by far.
So now that Republicans have won majority control of the Senate, and increased their majority in the House, what might that mean for Obamacare?
Here are four things to know and watch out for:
1) Obamacare continues to be political poison for Democrats. Of the 60 Senators who voted for Obamacare in December of 2009, 24 are now out, as The Washington Examiner's Philip Klein points out. Now, some of them were replaced by Democrats, but and not all of the turnover is strictly the fault of Obamacare. But the retention rate for upper-chamber legislators who voted for the law is not strong, and the majority of those who are gone were replaced by Republicans. It's worth singling out the Arkansas Senate race here. Incumbent Democrat Mark Pryor was the only Democrat in a close Senate contest to run an ad that could reasonably be described as supportive of Obamacare. Tellingly, the ad didn't name the law at all, but it did describe support for some of its benefits. Pryor lost, pulling in just 39 percent of the vote. In contrast, Ed Gillespie, the GOP Senate candidate in Virginia, was expected to lose by as much as 9 points. He was the rare GOP Senate candidate to endorse a relatively detailed Obamacare replacement plan—and he ended up losing in a squeaker of an election by less than a single point.
Pinning down the exact impact of Obamacare on the midterms is obviously difficult, but there's solid evidence suggesting that in 2010, voting for the law cost Democrats an estimated 25 seats in the House—enough that they lost control of the lower chamber because of it. Regardless of exactly how much Obamacare hurt Democrats politically, it's virtually impossible to make a case that it helped.
2) The bulk of Obamacare is not going to be repealed. Republicans have promised repeatedly to repeal Obamacare, and in a joint Wall Street Journal op-ed, GOP Senate Majority Leader Mitch McConnell and House Speaker John Boehner put "renewing our commitment to repeal Obamacare" near the top of the party's priority list. Expect to hear an awful lot about various strategies for using the reconciliation process, which would allow Republicans to move a partial repeal bill out of the Senate and to the president's desk with a simple majority vote. The details are complicated, and even experts don't know for certain exactly how much of Obamacare could be attacked using this process. The best guess? Most of it, perhaps, but almost certainly not all of it.
But at least in the short term the particulars don't matter all that much. Regardless of the party's commitment to repeal or its procedural savvy, the vast majority of the law isn't going anywhere, because Obama isn't going to sign a bill that repeals it. If it wasn't already perfectly clear that he wouldn't agree to scrap his signature accomplishment, he reiterated his position at a press conference this week. "Repeal of the law—I won't sign," he said. That's that.
McConnell knows this. Boehner knows. Republicans aren't actually expecting to fully take the law down. Instead, they hope to keep pressure on the president regarding the unpopular law, highlighting the GOP's continued opposition and Obama's continued support.
3) Republicans will likely target specific components of the law—and might actually succeed in taking a few of them out. Most of the law will stay in place. But Republicans might be able to nibble around the edges. At the press conference this week, President Obama indicated that he might be willing to accept some changes to the law, so long as they didn't impact coverage.
What sort of small tweaks might Republicans aim for? The most likely item on the list is a repeal of the law's medical device tax, which is opposed by many Democrats—particularly those who represent states where the medical device industry has a strong presence. Republicans will try to make an issue out of the individual mandate which is widely disliked, but Obama won't let that one get through. The employer mandate, however, might be a successful target: The administration has delayed and undercut the provision on multiple occasions, and liberal policy shops have argued that it's not necessary.
4) There are still more glitches to come. At the press conference, Obama was adamant that the federal health insurance exchange, which failed so thoroughly when it opened last year, would work well. "We're really making sure that that Web site works super well before the next open enrollment period," he said. "We're double- and triple-checking it." There's no doubt that the exchange, the front end of which was reasonably functional by the end of last year's open enrollment period, will perform significantly better when this year's open enrollment period starts later this month. But much of the back-end functionality—the guts of the system—remains incomplete, and that's going to cause some problems. As The Wall Street Journal reported earlier this week:
Consumers who bought policies on the exchange for 2014 and switch to a different insurer for 2015 could end up enrolled in two plans, with bills for both, in January, according to two industry officials. Others who stopped paying premiums for their plans this year could find themselves automatically re-enrolled in those plans for 2015 regardless of whether they want them.
Meanwhile, lower-earning Americans who receive federal tax credits to offset the cost of their coverage might not get a form they need to file their 2014 taxes because the federal government has an incorrect address for them, these officials say.
These issues are likely to have an impact on tens of thousands of people, according to the report, and some of them won't be apparent until tax time next year. Obamacare's second open enrollment period will be far smoother than last year's, but it will still be a bumpy ride.