WASHINGTON — Yes, if Mitt Romney wins the White House and his Republican allies retake the Senate, he could shred most of President Barack Obama's health care law without having to overpower a Democratic filibuster.

But it won't be as easy as some Republicans portend, and it certainly won't be quick.

Why?

Because any realistic effort to repeal the Affordable Care Act – as opposed to last week's quixotic vote in the GOP-controlled House – is sure to get jumbled together with lots of other issues, including Medicare, taxes, food stamps and defense spending.

And that's because Republicans have to first pass a budget. It's the only way than can invoke special Senate rules that allow legislation to pass with just a simple majority vote – instead of the 60 votes needed in the 100-member Senate to beat a filibuster.

Passing a budget requires answering a raft of questions unrelated to the relatively simple idea of repealing "Obamacare." How much to cut the deficit? Should Medicare be overhauled and Medicaid bear sharp cuts? Is it realistic to sharply boost defense programs, as Romney would like, in such an atmosphere?

The first step is to pass a budget resolution – a nonbinding, broad-brush outline of budget goals like cutting or increasing taxes, or slowing increases in Medicare. A budget resolution sets the terms for follow-up legislation that's called a reconciliation bill in Washington argot.

Two years ago, Democrats used a reconciliation bill to finalize the health care law with a 56-43, party-line vote in the Senate.

Republicans have a problem in that there's a lot more on their agenda than just repealing the health care law, and it's all going to have to be crammed into a budget resolution and follow-up reconciliation bill, too.

"They're going to want to use that budget resolution to set up a tax bill, they're going to want to do other deficit reduction," said Hazen Marshall, a GOP lobbyist and the Senate Budget Committee's top aide in 2001 and 2003 when reconciliation bills were used to push former President George W. Bush's tax cuts through Congress.

"So I would think it's just going to take some time to get everybody on the same page as to what the budget resolution's going to look like," Marshall said.

In 2001, when Republicans set about the relatively simple task of cutting taxes in an era of unprecedented budget surpluses, it took them until Memorial Day to pass the legislation.

What Republicans would confront next year is far more difficult – wrenching cuts to programs popular with voters. A more apt comparison might be the GOP's budget efforts of 1995, when it took the party until November to complete action on its budget plan.

"It's not that it's not doable. It absolutely is doable," said a senior House GOP budget aide. "It's just going to take a lot longer than everybody wants it to. And people aren't anticipating the pain of each step to get to that point." The aide spoke on condition of anonymity because he wasn't authorized to speak on the record.

Republicans currently hold 47 Senate seats. If they take control of the Senate, it's not likely to be by more than 1 to 4 votes, well short of 60. That would put lots of leverage in the hands of Senate GOP moderates like Susan Collins of Maine and Scott Brown of Massachusetts, should he win his difficult re-election bid.

Both Collins and Brown cast votes earlier this year against the House GOP budget plan, authored by Rep. Paul Ryan, R-Wis. At the center of Ryan's plan was controversial overhaul of Medicare that would transform it into a voucher-like program for those who retire in 10 years. Also voting against Ryan's plan was Rep. Denny Rehberg, R-Mont., who Republicans are counting on to win a Senate seat this fall as a building block to a GOP majority.

Keith Hennessey, a former GOP Senate and White House official, says that if Republicans follow past practice, they'll try to forge a center-right agreement that includes spending cuts but no tax increases. But he noted that the willingness of some Republicans to embrace tax increases could complicate matters.

"You look at the Republicans and you see that there's going to be a spectrum on how deep they're going to be willing to cut various things," said Hennessey, currently a research fellow at the Hoover Institution at Stanford University. "The question is just how far toward the Ryan plan can you get the moderate Republicans."

On the other hand, combining the repeal of Obama's health care law with other GOP priorities like curbing the deficit gives lawmakers who are not part of the leadership plenty of incentive to vote for the package.

"When elections are about certain policies and are defined on that, you've got momentum to do those things," said House GOP Whip Kevin McCarthy of California.

A simple-majority reconciliation bill could certainly cover the health care law's tax increases – including the penalties used to enforce the individual mandate to buy insurance – and subsidies for insurance premiums.

Republicans, however, could not use the filibuster-proof budget process to repeal provisions in the health care that don't have a direct impact on the government's balance sheet. For example, it still would likely take 60 Senate votes to repeal the law's requirement that insurance companies cover people with pre-existing conditions.

Experts say leaving the insurance reforms intact on their own is economically unsustainable because the ratio of sick to healthy people in the plans would be out of balance.

"If you were to remove everything else in reconciliation and be left with the insurance provisions, you have something that everybody recognizes is unworkable," said former Congressional Budget Office Director Douglas Holtz-Eakin. "I think if you take enough out, the rest probably has to go."

Also on HuffPost:

Loading Slideshow...
  • Round 1: The District Courts Divide

    U.S. District Judge George Caram Steeh, a Clinton appointee sitting in the Eastern District of Michigan, released the first major Affordable Care Act decision in October 2010. In <a href="http://www.mied.uscourts.gov/news/docs/09714485866.pdf" target="_hplink"><em>Thomas More Law Center v. Obama</em></a>, Steeh sided with the government to hold the law constitutional. "The decision whether to purchase insurance or to attempt to pay for health care out of pocket is plainly economic," Steeh wrote. "These decisions, viewed in the aggregate, have clear and direct impacts on health care providers, taxpayers and the insured population, who ultimately pay for the care provided to those without insurance."

  • Round 1: The District Courts Divide

    At the end of November 2010, another Clinton appointee, Judge Norman Moon of the Western District of Virginia, agreed with Judge Steeh. In <a href="http://www.vawd.uscourts.gov/OPINIONS/MOON/LIBERTYUNIVERSITYVGEITHNER.PDF" target="_hplink"><em>Liberty University v. Geithner</em></a>, Moon wrote that "by choosing to forgo insurance, plaintiffs are making an economic decision to try to pay for health care services later, out of pocket, rather than now, through the purchase of insurance."

  • Round 1: The District Courts Divide

    In December 2010, however, Judge Henry Hudson, a George W. Bush appointee sitting in the Eastern District of Virginia, ruled otherwise. In <a href="http://media.washingtonpost.com/wp-srv/metro/docs/Hudson_ruling.pdf?hpid=topnews" target="_hplink"><em>Virginia v. Sebelius</em></a>, Hudson struck down the individual mandate, writing that "an individual's personal decision to purchase -- or decline to purchase -- health insurance from a private provider is beyond the historical reach of the commerce clause." Importantly, Hudson also held that the individual mandate is severable from the rest of the Affordable Care Act, which means a court can strike it down while allowing the law's remaining provisions to stand.

  • Round 1: The District Courts Divide

    Finally in January 2011, Judge Roger Vinson, a Reagan appointee in the Northern District of Florida, evened the score but upped the ante. In <a href="http://www.scribd.com/doc/47905937/Health-Care-Ruling-by-Judge-Vinson" target="_hplink"><em>Florida v. Department of Health and Human Services</em></a>, not only did he strike down the individual mandate as exceeding Congress' power under the commerce clause, but he also took the whole health care law down with it. "The act," Vinson wrote, "like a defectively designed watch, needs to be redesigned and reconstructed by the watchmaker."

  • Round 2: The Appeals Courts Split

    In June 2011, the U.S. Court of Appeals for the 6th Circuit <a href="http://www.ca6.uscourts.gov/opinions.pdf/11a0168p-06.pdf" target="_hplink">upheld, by a 2-1 vote</a>, Judge Steeh's decision in <em>Thomas More Law Center</em>. Circuit Judge Jeffrey Sutton, a George W. Bush appointee, was the first judge chosen by a Republican president to reject the commerce clause challenge, writing that "no one must 'pile inference upon inference' to recognize that the national regulation of a $2.5 trillion industry, much of it financed through" national health insurance companies, "is economic in nature." He joined Judge Boyce Martin, a Jimmy Carter appointee, in the majority, while Judge James L. Graham, a Reagan appointee, wrote a vigorous dissent. In August, the 11th Circuit, reviewing <em>Florida v. HHS</em>, <a href="http://www.uscourts.gov/uscourts/courts/ca11/201111021.pdf" target="_hplink">produced a near mirror-image result</a>. Judge Frank Hull, a Clinton appointee, joined the Reagan-appointed Judge Joel Dubina to affirm District Judge Vinson's decision to strike down the individual mandate. Judge Stanley Marcus, a Clinton appointee, dissented, quoting heavily from Sutton's 6th Circuit concurring opinion. All three 11th Circuit judges found the mandate severable from the rest of the Affordable Care Act, reversing District Judge Hudson's decision to deep-six the entire law. Both appeals courts unanimously rejected the government's taxing power argument, insisting that if Congress had thought the penalty for not buying insurance was a tax, it would have explicitly called it a tax. On this issue, a third appeals court created another circuit split.

  • Round 2: The Appeals Courts Split

    In September 2011, the 4th Circuit dismissed two challenges to the health care law, finding that the plaintiffs did not have standing to bring their lawsuits. The panel did find that <a href="http://pacer.ca4.uscourts.gov/opinion.pdf/102347.P.pdf" target="_hplink">the penalty for not buying insurance was a tax</a> -- a good sign for the government's defense of the law. But rather than hold that the individual mandate was a valid exercise of Congress' taxing power, Judges Diana Gribbon Motz, a Clinton appointee, and James Wynn, an Obama appointee, said that another federal law, the Anti-Injunction Act, prevented the plaintiffs from challenging the mandate until they actually had to pay the tax -- which cannot happen before the provision goes into effect in 2014. The third judge, Obama appointee Andre Davis, said he wouldn't have dismissed the lawsuits and would have upheld the individual mandate based primarily on commerce clause ground. Regardless of the methodology, the Obama administration was now winning 2-1 in the courts of appeals against the Affordable Care Act's challengers.

  • Final Round: The Supreme Court Takes The Case

    The Supreme Court is most likely to choose to hear a case for one of three reasons: The constitutionality of a federal law hangs in the balance, the circuit courts disagree on the same issue, or the solicitor general advises the Court to take the case. Cases that fulfill just one of these considerations stand a good chance of reaching the justices. The health care cases had all three. In November 2011, the justices <a href="http://www.huffingtonpost.com/2011/11/14/obama-health-care-law_n_1092387.html" target="_hplink">agreed to review</a> the 11th Circuit's decision. To signal how seriously it took the challenges, the Court soon thereafter scheduled six hours of oral argument to take place from March 26 to 28, 2012. Normally, even for blockbuster cases, the justices only allot one hour for oral argument.

  • Final Round: The Supreme Court Hears Oral Argument

    All eyes turned to the Supreme Court in late March 2012 when the justices heard oral argument and gave their first public hints of where they stood on the Affordable Care Act's constitutionality. On the first day, March 26, liberal and conservative justices alike <a href="http://www.huffingtonpost.com/2012/03/26/health-care-law-supreme-court_n_1373455.html" target="_hplink">showed little interest</a> in following the 4th Circuit's decision to throw out the challenge to the health care law on a technicality before ever reaching the constitutional merits of the individual mandate. That display of unity disappeared on Tuesday, March 27, as the Court took on the <a href="http://www.huffingtonpost.com/2012/03/27/supreme-court-health-care_n_1373469.html" target="_hplink">main event</a>: two hours of argument over the mandate. The Court's four Democratic appointees all appeared to find the mandate well within Congress' powers to regulate interstate commerce, as the 6th Circuit had held; the Court's five Republican appointees, in concert with the 11th Circuit, seemed to think otherwise. Only in the final moments did swing vote Justice Anthony Kennedy soften his tone by musing aloud whether the health insurance market is different enough, after all, to allow a mandate to prevent cost-shifting where it might not be permissible in another market. "[M]ost questions in life are matters of degree," he said. On Wednesday, March 28, the justices <a href="http://www.huffingtonpost.com/2012/03/28/health-care-case-supreme-court-john-roberts_n_1386692.html" target="_hplink">considered</a> what other parts of the Affordable Care Act would fall if they found the mandate unconstitutional. No majority emerged. Several justices agreed with the challengers that the whole law must fall. Several others agreed with the Obama administration that two key (and popular) provisions could not survive without the mandate. Still others indicated some sympathy for severing the mandate alone and allowing the rest of the law to stand. A decision is expected by the end of June.