If Romney doesn't win, there won’t be a president willing to sign a repeal bill. | REUTERS 'Obamacare' foes fear GOP losses

If Mitt Romney doesn’t win the White House in November, and the Republicans don’t win the Senate, the GOP might not get another chance to repeal “Obamacare.”

That’s the reality of the 2012 election, and even the staunchest opponents of the Democrats’ health care reform law acknowledge it. By the time the 2014 election comes up, all of the law’s major changes will be in place. So if the Republicans don’t win control of the White House and Congress to repeal it before then, the goal of wiping away the law will probably be out of their reach.


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That’s why Romney’s latest struggles have a special significance for the repeal effort. If he can’t hit the reset button after his “47 percent” comments and his other campaign stumbles, there won’t be a president next year who would be willing to sign a repeal bill.

And if the Republicans don’t start doing better in the Senate races — where the Democratic candidates in the most critical races have been gaining ground — they won’t even have the power to get a repeal bill to the president’s desk.

So the most vocal advocates of repeal are hoping they don’t lose their last chance. Sen. Ron Johnson (R-Wis.), who says he ran for office because of his opposition to the health law, said the current state of the 2012 race “certainly tells me how crucial this election is.”

“This is really our last chance of stopping this and I think we really need to run the table,” Johnson said, “or this health care law, I fear, will be implemented. The history is once an entitlement is implemented it’s extremely difficult to turn back the clock.”

The vast majority of the health care law is due to go into effect in 2014. While much of the work to implement the plan has been under way since 2010, next year is when the big decisions will be made and the big checks will be written. After the health insurance exchanges are set up, the tax subsidies roll out and even the unpopular individual mandate is in place, it’s going to be extremely hard to repeal the law.

“I would think that it’s a foregone conclusion that if Obama is reelected, we're stuck with Obamacare whether we like it or not,” said Sen. Chuck Grassley (R-Iowa), repeating a sentiment that’s common among Republicans on Capitol Hill and in activist groups.

They’re quick to add that they’ll never stop fighting against the law. But the reality is that after unsuccessful attempts to stop the law in the Supreme Court, and without full majorities on Capitol Hill to pass a repeal bill before now, they won’t get another shot at a full repeal if there’s no Republican sweep in November.

Supporters of the Affordable Care Act, which President Barack Obama signed in March 2010, say they’re confident that the public is growing to appreciate the law’s benefits. Democrats put them on full display during this month’s Democratic National Convention in Charlotte, N.C., where several speakers spoke about the law.

But the ideal scenario for opponents of the law is that Romney wins the White House and Republicans gain control of the Senate — and the prospects of both are on the decline. If things turn around by November, the plan in 2013 would be to use the budget reconciliation process to repeal as much of the law as possible through Congress. Romney’s administration would also slow the law’s progress through regulation.

“Obviously losing this election at the presidential and Senate levels would be a big setback for the repeal movement,” said Dean Clancy, vice president for health policy at FreedomWorks, which is working to defeat the law.

Without a Republican in the White House to sign repeal, opponents of the law would be left to merely bite around the edges and hope to keep whacking at the legislation in small pieces.

“If President Obama wins, it will be forced into a defensive posture and guerrilla warfare,” Clancy said. “The fight will go on, but full repeal will become much, much more challenging.”

Republicans could also pursue blocking the law through cutting out funding in appropriations, which would be useful if Republicans control the Senate and House but not the White House.

But even defunding and reviewing regulations in the Department of Health and Human Services “come up short of outright repeal,” Grassley said.

Sen. Jim DeMint (R-S.C.) said Democrats built the law to provide benefits that would be hard to take away from people, even if the rest of the law doesn’t work.

“If Romney doesn’t win the presidency and probably if we don’t take the Senate, it’s going to be very difficult to turn it around,” he said. “There’s going to be so much infrastructure set up, and part of what the Democrats count on is that the more people become dependent, the harder it is to take it away. And that’s part of the game.”

The business community is also already putting its own changes into place to prepare for the law, said Grace-Marie Turner, president of the Galen Institute, which opposes the law. She says that the more time the business community spends on preparing to implement the law, the harder it will be to “undo” it.

If the law’s not repealed before 2014, “you’re going to wind up with such a restructured health system once the subsidies start to flow, it’s going to be hard to fix this,” she said.

This article first appeared on POLITICO Pro at 3:39 p.m. on September 21, 2012.