Obama supporters worry a Romney victory will kill parts of healthcare law

The prospect of a Romney
presidency is making some supporters of President Obama’s healthcare law
increasingly nervous.

Romney has a narrow edge over
Obama in national polls, and has closed the gap or taken the lead recently
in several key swing states. As his chances of winning have seemed to improve,
his plans for the Affordable Care Act are getting a closer look.

{mosads}“Yeah, I’m nervous,” said Tim Jost, a Washington and Lee
University law professor who strongly supports both Obama and the healthcare
law.

Romney has vowed to repeal the Affordable Care Act (ACA). But
because that would require 60 votes in the Senate, he has also said he would
issue “waivers” and executive orders to weaken the law as much as possible on
his own.

Romney said during Monday’s debate that he would reverse
the healthcare law “as much as humanly possible.” Asked whether that was a
tacit acknowledgement that all-out repeal is unlikely, Romney’s campaign said
he was simply reiterating that he would do what he could as president while working
with Congress on repeal.

Jost said his concern for the future of the healthcare law
is part of what motivated him to donate to Obama’s campaign. A Romney
administration probably would be able to at least slow down the law’s
implementation, Jost said. Romney’s Health and Human Services Department might
start missing deadlines or dragging out rule-making processes.

“So I’m concerned, and I don’t think people are very aware
of” how much damage Romney could do, he said.

Michael Cannon, a healthcare
analyst at the libertarian Cato Institute who strongly opposes the healthcare
law, said he’s not sure how much a President Romney could do on “day one.”
Cannon is also still skeptical about Romney’s commitment to repeal — a question
that dogged him throughout the Republican primary.

“He may decide to tack to the center on ObamaCare … you
never know with this guy,” Cannon said.

But if Romney sticks to his guns, he might be able to start
with one of Cannon’s top priorities: eliminating insurance subsidies in the
federally run insurance exchange. The ACA sets up exchanges in each state, with
a federal fallback in states that don’t act on their own.

Most people who are able to use the exchanges will get a
subsidy from the federal government. The IRS has said it plans to administer
those subsidies in both the state-run and federal exchanges. But Cannon says
that’s illegal, and subsidies should only be available in state-based
exchanges.

If a Romney administration took the time and effort to
reverse the IRS’s policy, it would wreak havoc on the insurance marketplace.

“The moment the president says, ‘I’m not going to do that,
kill that rule,’ panic sets in — insurers say, ‘Whoa, wait a minute, we can’t
work under these conditions,’ ” Cannon said.

He’s hoping that some centrist Democrats could be persuaded
to revisit the Affordable Care Act if a change from the administration, or
rising premiums, forces their hand.

“There are ways to approach ObamaCare, ways to try to move
the needle so that you change votes in Congress,” Cannon said.

Democrats seem poised at the moment to hold on to their
Senate majority, even if Romney takes the White House. Incumbent Democrats
Claire McCaskill (Mo.) and Bill Nelson (Fla.) appear safe, and Democratic
challengers in North Dakota, Indiana, Arizona and Massachusetts are in
surprisingly strong position with only about two weeks left until Election
Day.

That means Republicans probably won’t rack up the 60 seats
they would need for a straightforward repeal vote. If they win even a one-seat
majority, they could attempt to repeal parts of the law through the budget
process known as reconciliation.

But reconciliation is a complicated process that couldn’t be
used to repeal the whole law. And the mess of remaining provisions could cause
chaos and rising premiums that would dwarf even the most pessimistic estimates
of the existing law.

If Democrats keep the Senate or Republicans shy away from
reconciliation, the ball would still be in Romney’s hands. There’s not much he
could do about straightforward rules like the policy requiring insurers to
cover people with pre-existing conditions, but the federal exchange remains a
possible target.

The Affordable Care Act doesn’t explicitly set aside any
funding for the federal exchange; HHS is cobbling together money from other
programs and tapping a general implementation fund. The lack of direct funding
could help Romney starve the federal exchange — if he wants to.

“Will he divulge where the money has been coming from?”
asked Cannon. “Will he stop spending money on that? Or will he keep spending
money on that because his buddy Mike Leavitt thinks they’re such great things,
and by the way, he makes money off them?”

Leavitt, a former HHS secretary, is leading Romney’s
transition team. He runs a consulting business that has helped states plan to
set up their exchanges.