At last Tuesday’s debate among the Republican presidential candidates, former Massachusetts governor Mitt Romney and former U.S. senator Rick Santorum both mentioned that repeal of Obamacare could be accomplished through the special budgetary procedure known as “reconciliation” (see thisvideo clip of the debate exchange, courtesy of Avik Roy’s enlightening Forbes.com post on the subject). This bit of Washington inside baseball was unusual in a presidential-debate setting; most of those in the audience watching at home probably have no earthly idea what the budget-reconciliation process is, nor should they. But in the long fight over Obamacare, what Romney and Santorum said about the use of reconciliation is a crucially important point that has the potential to dramatically affect the future of American health care.

If, in the 2012 election, Republicans are able to maintain control of the House, pick up the majority in the Senate (a real possibility) but not a 60-vote supermajority, and win the White House (looking more possible by the day), the GOP would be in position to set in motion a reconciliation bill to repeal and replace Obamacare — and they wouldn’t need any Democratic cooperation to make it happen. The fact that leading Republican presidential candidates have now said that reconciliation is an option is a big deal, as it makes it very clear to all concerned that there is a clear path to victory for Obamacare opponents.

Obamacare was jammed through Congress against the wishes of a majority of the electorate. Voters took it out on those controlling Congress in the 2010 midterm election, which was a Republican rout of historic magnitude. The opposition to Obamacare remains just as strong today as it was last year, which means the 2012 election could produce a similar result. Except that, unlike 2010, in the aftermath of the coming election there could very well be a straightforward and unimpeded path for delivering on repeal and replace, as the voters are demanding.

Continue reading →