Obamacare Under the Knife

In the nearly 10 months since the Democrats' health care bill became law, bureaucrats have been feverishly writing new regulations, and the first wave of reform has arrived. There are tax credits for small businesses to cover employees; kids can stay on their parents' policies until they are 26; co-pays for preventive care went away. But to most Americans, the enactment of the Patient Protection and Affordable Care Act has felt less like the dawn of a new era and more like the start of a long partisan war over whether reform should proceed at all.

The new Republican majority in the House of Representatives will vote to repeal the entire health care reform law on Jan. 12. If (as expected) the Senate does not follow suit, the House will then try to dismantle it "piece by piece," in the words of Michigan's Fred Upton, the new chairman of the chamber's Energy and Commerce Committee. "We'll see if this thing will crumble," he says. Elsewhere, lawyers are challenging the constitutionality of central components of the law in federal courthouses and are likely to carry their arguments all the way to the Supreme Court. Republican governors are proceeding in kind, supporting those lawsuits and resisting the law inside their state borders, even as they take the millions in federal funds that come with it. (Read "After a Rocky Year, No Celebrating for Health Care Reform.")
While wholesale repeal is virtually impossible, there is no guarantee that the shaky coalition Obama glued together to get the landmark bill passed last year will hold. In the midterm-election campaigns, Democrats found themselves under fire for backing a new expansion of federal entitlements. Some of those who expect to face tough contests in 2012 may decide to hedge their bets on subsequent votes to defend or dismantle the law. One House Democrat, Dan Boren of Oklahoma, has already said he is "inclined to support the repeal." Physicians' groups, hospitals, insurers and drugmakers, which reluctantly got behind the measure last year, will stick with the law only if its implementation appears to be stable and predictable. Major legislative revisions, which are not impossible, may cause their support to evaporate. It is almost certain that the law will be changed before the 112th Congress adjourns next year.

How much? History may be a useful guide. The creation of Social Security in 1935 and Medicare in 1965 spawned lawsuits and promises of repeal too. Yet in the years that followed, neither program was scaled back. Both, in fact, were greatly expanded. Here's a look at the war on health care reform - and the fronts on which the battles of 2011 will be fought.  Leave your Comment on this story.