WASHINGTON -- Former White House budget director Peter Orszag said Monday that it's possible, given a particular outcome in the November elections, that Republicans could use Senate procedural rules to gut President Barack Obama's health care law. But don't count on it.
If Mitt Romney wins the presidential race and if Republicans take the majority in the Senate, "it opens up the possibility of using reconciliation to repeal significant components of the Affordable Care Act," said Orszag, speaking on a conference call with reporters.
Specifically, that would mean that sometime next spring, the Senate might adopt a budget resolution that included instructions to torpedo the core elements of the health care law. The Senate's budget reconciliation process requires only 51 votes to get things done, which means that if Republicans became the majority, Democrats wouldn't be able to lean on the Senate's 60-vote filibuster-proof threshold to block such an effort. Democrats currently hold a slim majority in the upper chamber.
But Orszag, who served under Obama for a year and a half, said even in the event that Republicans won big in November, it would still be difficult to use the reconciliation process to substantially alter health care reform. For starters, he said, repealing the law entirely would add to the deficit, which means Republicans would have to come up with some major offset. Moreover, reconciliation matters are supposed to be budget-related, he noted, which "may prove challenging" for Republicans to claim about repealing the Affordable Care Act.
"It's really down to a scenario in which it will matter if the trifecta of the House, the White House and the Senate are all controlled by one party," said Orszag, who is now vice chairman of global banking at Citigroup. "As long as that's not the case, and there is some form of divided government, the vast bulk of the other provisions will stand, with perhaps some of the least popular provisions coming under targeted pressure."
Orszag also predicted that most states will take advantage of federal subsidies to expand their Medicaid programs under the health care law. Some Republican governors have recently said they won't take the extra federal dollars to cover more Medicaid recipients, but Orszag guessed that "over time, more and more states will find a 90 percent subsidy is going to be very difficult to resist."
Ultimately, what people can expect in the near future are some legislative and policy changes in health care, many of which are already happening, Orszag said.
"The bottom line," he said, "is we'll have a much better health care system a decade from now than we have today."