Sept. 20, 2010 -- New health care measures go into effect this week that will have profound implications for all Americans and on the U.S. health care system. But Republicans are still fighting for the repeal of the bill that has become one of the biggest and most controversial health care laws in history.
But a full repeal isn't completely out of the question. The Medicare Catastrophic Coverage Act, which would have been the biggest expansion of Medicare since the 1960's, was repealed in 1989, just one year after it passed.
A full repeal would require a bill to pass in both the House and the Senate, and would need a majority in both Houses. Even if Democrats lost majority control, they still would be able to filibuster it. And even if the repeal bill were to pass both Houses, it could most likely be vetoed by President Obama. A presidential veto can only be overturned by a two-third majority in both the House and Senate.
A more plausible option that Republicans are considering is rejecting funds for various parts of the health care bill and striking down some measures specifically, such as the mandate that would require all Americans to have health insurance. But, again, that would require that Republicans have full control of Congress.
Even though 35 House Democrats did not vote for the health care bill, only one -- Rep. Gene Taylor, D-Miss. -- supports repeal.
Republicans themselves admit that repealing the entire bill is virtually next to impossible.
"I would like to repeal it and replace it," Senate Minority Leader Mitch McConnell, R-Ky., said recently. "What can we do? We can make narrow, targeted efforts to go after the cost problems. Without the president, we can't repeal it. But we can go after portions of it aggressively."
Even House Minority Leader John Boehner, R-Ohio, an outspoken proponent of repeal, refused to use the word when posed the question at a press conference last week.
"I am committed to doing everything that I can do and our team can do to prevent 'Obamacare' from being implemented," Boehner said. "I believe that this bill will ruin the best health care system in the world, and I believe that it will bankrupt our country. And when I say everything, I mean everything."
Republican leaders say they don't expect to make an impact overnight, and insist that this is a long-term strategy. By chipping away at the bill piecemeal, they can reduce its overall effectiveness and make it so weak that it essentially doesn't work.
"Eventually, you have something that looks like Swiss cheese and will, frankly, be about as sturdy as Swiss cheese," Rep. Bill Cassidy, R-La., a practicing physician and assistant whip for the Republican Conference, told ABC News. "And then that will be the point where you replace it with something that achieves the goals of controlling cost, expanding access to quality health care but also reflects the value of the American people."
Voices for Repeal Grow Louder
Even as voices for repeal grow louder, the Congressional Budget Office warned last month that repealing key provisions from the health care bill that generated savings for Medicare, Medicaid, or the Children's Health Insurance Program, could increase the deficit by $455 billion.
Many Democrats also are not taking the threat seriously, insisting that once Americans see the benefits kick in, they ultimately will fight against repeal.
In March, Obama dared Republicans to repeal the bill.
"If they want to have that fight, we can have it," the president said at an event in Iowa City. "Because I don't believe that the American people are going to put the insurance industry back in the driver's seat. We've already been there. We're not going back. This country is moving forward."
Democrats are launching major efforts this week to make Americans aware of the changes they will see in their health care plans.
Support among the public has dipped in recent months. The Kaiser Family Foundation's August Health Tracking Poll found that 43 percent favored health care reform, lower than 50 percent in July. Forty-five percent of those polled had an unfavorable view of the law.
A CBS/New York Times poll released last week found that 37 percent of Americans approved of the law, while 49 percent disapproved. However, less than half of those polled, 40 percent, supported repealing the law, and the number decreased even more when the question of each provision, such as the pre-existing condition, was posed.
"The bottom line to that is as more and more people learn about what's in the health reform law, you're going to see an increase in the number of people who say ... 'We support it,'" said Ron Pollack, executive director of Families USA, which has spent between $7 million and $8 million to educate people about what they say are benefits of the new law.
"That's not going to happen overnight," Pollack said. "Those things take time to be absorbed. Over time, you will see that shift."
But opponents of the bill argue that many of the benefits are being overstated.
"Congress must sit down with a blank slate and have an honest and open process to improve America's health care system by empowering patients and their doctors," said Heritage Action for America's chief executive Michael A. Needham, who heads grassroots efforts to push for repeal. "If the law were repealed, nobody would have their perceived benefits stripped away retroactively."
Starting Sept. 23, insurance companies would have to implement several new measures upon renewal, which include no discrimination against children with pre-existing conditions, prohibition against rescinding coverage, prohibition on lifetime limits on insurance coverage and allowing children up to the age of 26 to be included on their parents' plans.