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The ACA, implementation, and possible repeal....

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So, I'm posting this in order to clarify something, I recently had this discussion with some of the physicians at work while we were in a meeting discussing our ongoing change to our delivery model. This isn't about which party is better, or my johnson is longer than yours...This is purely a technical discussion..by that I mean...that


this is a technical discussion about the possibility of a President overturning the ACA. It was recently promised that it would be "repealed on day one".


Unfortunately, for the GOP, this is not possible. As discussed in this Health Affairs article here:




The POTUS does not have unlimited powers as Nixon found out. He cannot simply "sign away" a law. Unless the GOP can take control of the Senate with a 60 vote majority, this is not possible. The chances of that rank somewhere around the possibility of a Zombie Apocalypse...in fact, the zombie apocalypse might be more likely. Right now, Nate Silver (538) predicts a 90.9% chance that the Dems will retain control of the Senate with a 52.6 seat majority.


So an outright repeal is not possible. Not at all. Don't even think about it, it simply cannot happen unless the GOP can convince 13 Dems to join them. At which point, I will simply smile and wait for the Zombies to come.


Which brings us to option two....They can try to defund the ACA, and/or repeal parts of it through reconciliation. This is popular as an idea, but there are a few problems 1. it relies on at least a 51 vote majority, which means it would only take 4 Dems to jump ship, which, see above, won't likely happen. Also, ANY Senator can raise a point of objection, and if upheld by the parliamentarian (technical I know), the vote requires a 3/5th's majority to pass. So, it is not a sure thing...not by a long shot, but it has a better chance than outright repeal. Of course, doing this would create unintended consequences as the bill would be bastardized and likely end up doing a lot more harm than any good that it could have.


Option three is also popular in GOP circles on the hill now, and that is to pass Legislative Riders, that block the implementation of the bill.....but this still requires 51 GOP votes in the Senate which are unlikely right now....


So what can a POTUS opposed to the ACA do? He can mess with implementation, drag his feet...(although as mentioned in the link above, Nixon found out that the Courts DO NOT take kindly to this)...but ultimately, any changes will be small and limited.


Let's learn to live with it for now.

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Great analysis. Repeal of the ACA is essentially impossible given the political realities of Washington. If Romney is elected, he is in for a rude awakening when he discovers that he is not CEO of the US, that the US government is not a "business," and he can't fire anyone but his own cabinet and can't make anyone in government do anything they don't want to do.

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