By Robert I. Field, Ph.D., J.D., M.P.H.

Mitt Romney says that, if elected, he would repeal Obamacare on day one. Obama, needless to say, would see it through to full implementation in 2014.

But will the election really determine the ultimate fate of health reform? Probably not. That’s the opinion of numerous experts.

If Romney wins, he is almost certain to ignore his own pledge. In fact, he has even said so. On September 9, he told NBC’s Meet the Press, “I’m not getting rid of all of healthcare reform ... Of course, there are a number of things that I like in healthcare reform that I’m going to put in place.”

Two things he would keep are insurance protections for people with pre-existing conditions and a requirement that families be allowed to keep adult children on their coverage. But he left the door open to keeping others, as well.

He has yet to explain how he would repeal all of Obamacare and keep portions of it at the same time. However, his promise to fully repeal it would be almost impossible to keep.

For one thing, even as president, he wouldn’t have the authority to rescind the law. Health reform is embodied in an act of Congress, and it would take another act of Congress to repeal it. The Constitution doesn’t permit the president to take such an action on his or her own.

He could ask Congress to pass a repeal bill, however both houses would have to go along. That would require 60 votes in the Senate, and it is highly unlikely that the Republicans would gain that many.

Short of repeal, Romney could delay implementing all or part of the law. His administration could decline to issue necessary regulations, or it could drag its feet in putting key elements, like the insurance exchanges into place. 

He could also ask Congress to withhold funding for implementation. Republicans would only need a simple majority in the Senate to get that through, because budget bills do not require 60 votes.

However, either of those steps could lead to chaos. Many states have started to set up exchanges for selling insurance policies under the law, and many businesses have made plans that rely on them. Halting implementation mid-course could send some health care markets into turmoil.

For another thing, once in office, Romney could well decide that he doesn’t really want to repeal Obamacare, after all. Parts of the law, such as the protections for insurance consumers, are highly popular, even among Republicans. He seemed to acknowledged as much himself in the Meet the Press interview.

And much of the law has strong support in the business community. Insurance companies, pharmaceutical firms, hospitals, and many other industry sectors have much to gain. The law will bring them millions of new customers. 

In the words of a high-ranking hospital industry official, health reform “was built on tracks that were already laid down. Who’s going to stand in the way of the progress we’ve made?”

On the other hand, if Obama wins, full implementation will still be challenging. A tremendous amount of work remains to be done before all of the law can take effect. Delays and changes in plans are almost certain to occur.

This is not to say that American health care would look the same under either candidate. Their attitudes differ in many important ways.

However, elements of Obamacare are likely to remain regardless of the election’s outcome. The reality of health reform is much more complex than campaign slogans would suggest.

For other perspectives on the issue, the Drexel schools of law and public health will hold a conference on Friday, November 16 to consider the meaning of the election’s results for health reform. For more information, please click here.