I have it on good authority that there are basically three outcomes that the health reform law may experience in the future (other than becoming a resounding–or mediocre–success). They are:
1. The Republicans get elected to a veto-proof majority and repeal the law in its entirety.
2. The Republicans get elected to a simple majority and are able to attack the law by reducing funding for a number of its provisions.
3. The lawsuits being brought against the law are successful and the individual mandate is found to be unconstitutional. Consequently, the entire thing unravels.
As to Option 1, I don’t see it happening. Is the GOP going to pick up seats in November? It would be historic if they did not. Will they pick up enough seats to override Obama’s veto and repeal health reform? I doubt it. Even if they did pick up the necessary seats, they might suddenly find out how hard it is to hold the votes together, especially considering that repeal isn’t going to be any easier politically than passage was. The obstacles here are huge. I’ll do a little forecasting, and say there’s about a 1% chance that this happens.
Option 2 is much more likely, because all that would be needed is a simple majority in both chambers. I put the likelihood of this one at about 30%, and that number would get greatly revised upward or downward after the election. After all, if the GOP can throw a wrench in the works without repealing reform, the end result will be pretty much the same, but with one major difference: Option 2 lets them say “Hey, Look! The Democrats’ health reform didn’t work!” They don’t have that luxury if they repeal the thing.
Lastly, Option 3. The courts are unpredictable. After all, this is the kind of case that would make its way up to the Supreme Court, and then you’re only talking about winning five votes in a best-of-nine series. (Sorry, the baseball postseason just started.) I’d give this one about a 20% chance of happening.
If you’re tracking with me and doing the math, that means I put the likelihood of health reform facing a serious challenge to implementation at 51%. Again, that’s without knowing how the elections will turn out. Still, the threat is quite real. Equally as real is the threat posed by the GOP’s proposed alternative to health reform as outlined in the Pledge for America. (As another aside, I can’t wait until another 16 years go by and we get the Promise to America to make the hat-trick with the Contract with America. But Washington never recycles ideas.) Others have had some good takes on the problems with what is being proposed. You can read them here, here, and here.