To: JohnM who wrote (192820 ) 6/29/2012 5:46:34 PM From: koan Respond to of 542907 I would point out those 10 or 15 blue dog dems, that hindered reconciliation, are the moderates, so many feel are the rational dems. Obama constantly placated those dems, like allowing Lieberman to keep his chairmanship. He and harry Reid should have put the fear of god in them, like Trent Lott did. <<And that brings us to the “repeal” scenario. Several pundits (notably David Frum and Ryan Lizza ) have rejected the idea a Republican-controlled Congress would have the power or will to repeal ACA. Lizza in particular leans on the procedural difficulties of using “reconciliation” to achieve repeal, though missing, I suspect, the important fact that the Court’s construction of the individual mandate as a “tax” will make it much easier for a hostile Congress to treat its repeal as a budget measure. For my money, Matt Yglesias is dead-on in rejecting these breezy assurances: n the real world there are very few practical constraints on reconciliation. The operational issue the Obama administration had with reconciliation is that there were a clutch of 10-15 Democratic Senators who preferred a 60-vote Senate because it put shifted the pivot point and put policy outcomes closer to their personal ideal points. It was those Senators who raised a lot of niggling objections about reconciliation rules. The GOP is more ideologically unified and more focused on advancing a broad conception of the national interest rather than parochial concerns of individual legislators. That’s accurate history, as is Matt’s reminder of how then-Majority Leader Trent Lott dealt with a Senate parliamentarian who was too scrupulous about reconciliation when Republicans were whipping the Bush tax cuts through the Senate in 2001 (Lott fired him). So all in all, I’d say implementation of ACA remains pretty strictly contingent on the November elections. If Republicans win the White House and control of both Houses of Congress (and the two outcomes remain likely to be linked), the odds are high they would attempt a total (or near-total) repeal of ACA in the context of enacting a Ryan Budget that would, of course, radically reverse progress towards universal health coverage far beyond where we were in 2010. If they lose in November, or (for the sake of argument) fail to get control of the Senate, then the big question is whether an enraged conservative movement begins looking for other options for mucking up ACA implementation, at which point demands on Republican state lawmakers to block the Medicaid expansion will be ratcheted up to a high-pitch chattering whine. UPDATE : Note this New York Times piece from Kevin Sack and Reed Abelson outlining what states must do when to implement ACA, which confirms much of the above about the “keep all options open” position of Republicans in the states at the moment.