How Republicans could block healthcare reform

A patient waits in the hallway for a room to open up in the emergency room at Ben Taub General Hospital in Houston, Texas, July 27, 2009.

WASHINGTON (Reuters) - Republicans could keep their promises to stop healthcare reform even if they cannot repeal it, simply by blocking legislation needed to pay for it, one expert argued on Wednesday.

Control of one house of Congress could give the Republicans power to cripple the law, creating "zombie legislation," healthcare expert Henry Aaron of the Brookings Institution wrote in a commentary in the New England Journal of Medicine.

Healthcare reform is President Barack Obama's signature policy.

The Affordable Care Act passed in March without a single Republican vote. It is supposed to get health insurance to 32 million Americans who currently lack it, help set up local clinics to help provide needed care, set new standards for health insurance and, eventually, begin to transform the fragmented U.S. healthcare system.

Many Republicans running for Congress in November have been promising to roll back as many of its provisions as possible or even to repeal it if they gain control of both the House of Representatives and the Senate.

Repeal would be unlikely, Aaron said, as Obama would veto any such attempt.

Republicans are headed for gains in both chambers in the November 2 elections and could take control of the House, but are not expected to win enough seats to override a presidential veto.

ZOMBIE LAWS

"A more serious possibility is that ACA opponents could deliver on another pledge: to cut off funding for implementation," Aaron wrote.

The legislation authorizes spending, but the actual cash must be appropriated in a second process. The ACA has more than 100 separate authorizations calling for spending of well over $105 billion between now and 2019.

"None of these funds will flow, however, unless Congress enacts specific appropriation bills," Aaron wrote.

Members of Congress could stop staff from working on rules for implementation, Aaron said.

"The nation would then be left with zombie legislation, a program that lives on but works badly, consisting of poorly funded and understaffed state health exchanges that cannot bring needed improvements," he said.

"They could even bar the DHHS (Health and Human Services Department) from writing or issuing regulations or engaging in any other federal activity related to the creation of health insurance exchanges," Aaron added.

"That would set the stage for a high-stakes game of political 'chicken'," he said. Obama could veto any bills, but Congress could shut down the government by refusing to pass any appropriations.

Paul Howard of the Manhattan Institute, a right-leaning think tank, said Aaron was right.

"This looks like a tactic that is very likely to be tried," Howard said in a telephone interview.

"Legislatively, this is probably going to be the game."

But Howard said he doubted Republicans would simply want to cripple legislation.

"They are going to propose alternatives," he said.

"There is the potential here for some conversation for what healthcare reform should really look like going forward."

House Republicans, in their recently unveiled "Pledge to America" governing agenda, promised to "repeal and replace" Obama's overhaul of the U.S. healthcare system.

House Republican Leader John Boehner, in line to become House speaker if his party wins control of the chamber from Obama's Democrats, recently declared that he and his team are committed to doing all they can to stop the president's plan from being implemented.

"And when I say everything, I mean everything," Boehner told reporters.

A number of public opinion polls the past year have shown broad disapproval of Obama's healthcare overhaul, so much so many Democrats up for reelection distance themselves from it.

But a survey last month by the Public Religion Research Institute found that 54 percent of respondents said they would be more likely to vote for a candidate who backed it.

The PRRI survey of 3,013 adults was conducted from September 1 to September 14. It has a margin of error of 2 percentage points.

(Additional reporting by Thomas Ferraro; Editing by Eric Walsh)