There's an ongoing debate among Republicans about what it means to repeal Obamacare. Does it mean abolishing the whole thing? Does it mean nullifying just the most troublesome parts? Repealing and simultaneously enacting a new set of reforms? Or repealing and then starting a new debate on what reforms to make?
If the GOP wins control of the House this November on the promise to repeal Obamacare -- what do they do? Even if they repeal Obamacare, Barack Obama will still be president and the Senate will still be the Senate, meaning that, absent a huge shift in the political atmosphere, the chance of final success will be small. What then?
That was a topic of much discussion during a conference call last week among House Republicans. First, of course, they have to win control of the House. If that happens, they are united in their resolve to repeal Obamacare and pass in its place a series of measures addressing the public's most pressing healthcare concerns. But since they know it is highly unlikely they could overcome an Obama veto, they are also working on provisional plans to use the House's spending power to cut funding for parts of Obamacare before it even comes into existence.
"House Republicans will not rest until we repeal Obamacare lock, stock and barrel," Rep. Mike Pence, head of the House Republican Conference, told me from Arizona, where he had gone to campaign for GOP candidates. "I believe that's the uniform position of the Republican leadership."
"People are livid," Rep. Tom Price, head of the Republican Study Committee, said during a break from campaigning for Republicans in Georgia, Alabama, Tennessee, Louisiana, North Carolina and New York. "They can't believe what this administration and Pelosi and the gang are doing."
"If we are not unanimous as a conference in being for repeal of 100 percent of Obamacare, then we're fractured as a party," Rep. Steve King, a favorite of the Tea Party movement, told me from Minnesota, where he was appearing at a rally with Tea Party superstar Rep. Michele Bachmann.
At the same time, the lawmakers are aware of what Pence calls the "rabbit snare" of a repeal-only strategy. "We repeal and start over," Pence emphasized. "Don't forget the 'and.'"
The lawmakers know what Democrats will say. They'll point to three things -- banning discrimination against pre-existing conditions (which is years in the future), filling the Medicare prescription-drug "donut hole," and extending dependent medical coverage until age 26 -- and say, "Republicans want to take all those good things away from you." Obama has already issued a trash-talk challenge to the GOP: "Go for it."
Republicans know those features are popular with independent voters, and they plan to enact what Price calls "patient-centered" measures to address them. It's a debate they're prepared for. "The response is, 'You could have done those things without having government take over health care in our country,'" said Price, who is a medical doctor. "What about the $500 billion in new taxes? What about the individual mandate and penalties, which most people think are unconstitutional? What about the usurpation of family decision-making in health care?"
Given today's political trend lines -- continuing opposition to Obamacare and support for repeal -- it's possible that argument could be enough to win the House. But House Republicans know it is unlikely that the Senate will also go to the GOP, and even if it does, there might not be sufficient support there for repeal, and even if there is, and the whole thing passes Congress, Republicans won't have enough votes to override a presidential veto.
In that case, several lawmakers told me, House Republicans will focus on the parts of Obamacare they can control. "We would have a number of tools at our disposal," Pence said. "Chief among them is the power of the purse, the ability to shape any rollout of Obamacare or constrain any rollout through the appropriations process."
"There are 159 new commissions, czars, councils and entities within the Department of Health and Human Services, and if they weren't funded, they would have a hard time existing," said Price.
That's one glaring vulnerability in the Democratic strategy to pass national health care now but push its enactment years into the future. Things can change. Perhaps Obamacare cannot be repealed, but it might be reshaped and virtually undone. If Republicans win control of the House this November, that's a fight you're going to see.