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House set for health care law repeal vote

US Capitol, US Flag and Stethoscope

(CBS News) The House of Representatives will vote this week to repeal President Barack Obama's health care law. The vote, which was announced by House Republican leaders immediately following the U.S. Supreme Court's health care ruling, will be the 31st time the Republican House will have voted to repeal or defund all, or part, of the Affordable Care Act.

But the move, like most of the votes before, will lead to nothing. The Democratic Senate won't consider it. And even if a sprinkle of magic fairy dust fell over the Capitol dome, and the House and Senate somehow agreed to repeal the law, Mr. Obama has the ultimate say with his veto pen.

That could all change next January depending on November's election results. The Supreme Court ruled that the heart of the health care law, the individual mandate, is constitutional, but that does not mean Congress can't change the law in the future. Of course, repealing the law won't be easy and many things would have to fall in just the right place for Republicans to get their way.

Here's the list of the many events that would need to take place for Republicans to succeed in repealing the law before key provisions are fully implemented in 2014:

Mitt Romney wins in November

As mentioned earlier, the president has veto power to strike down any law Congress passes. Congress can override a presidential veto, but it needs two-thirds of both the House and Senate to vote in favor of doing so. Congress has only overridden seven vetoes in the past two decades. Even if Republicans take all of Congress but President Obama stays in the White House, the health care law would stay in place as Democrats envisioned the law.

Republicans take the Senate - and win BIG

One quirk of the Senate that House members from both parties bemoan on a regular basis is that it usually takes 60 votes to do almost anything in the Senate. Want to bring a bill to the floor? Takes 60. Want to end debate? Takes 60. These are the big votes. The final vote on passage is usually an afterthought if senators are able to clear that 60-vote threshold. The current breakdown of the Senate is 51 Democrats, 47 Republicans, and 2 independents that caucus with the Democrats. That means Republicans would need to pick up at least 13 seats for a filibuster-proof majority. While it is possible Republicans could take the four seats needed for a majority in the Senate, no one is predicting they will win so many seats that they would have what's known as a "super majority" with 60 Republicans. Senate Republican leader Mitch McConnell told a local Rotary Club audience recently that repealing the health care law would be the first item on the agenda if they win the Senate, but repeal won't be that easy.

Republicans keep the House

Democrats need 25 seats to take back the House of Representatives. Republicans currently hold 242 seats while the Democrats have 191. The magic number is 218. Congressional prognosticators like Stuart Rothenberg predict that "a Democratic gain in the single digits is most likely." Democrats have an uphill battle to win this chamber back after the wave that ushered in the Republican majority in 2010. Republicans must hold on to the House for any chance at health care repeal.

The only real path: Republicans sweep Washington and engage in budgetary gymnastics

The only likely path for actual repeal of the health care law would require that Republicans win everything in November. A clean sweep of the presidency, the House and the Senate. Since it's unlikely Republicans will win a filibuster-proof majority in the Senate, Republicans would have to repeal as much of the law as possible through what's known as the budget reconciliation process. A process that current House Budget Committee Chairman Paul Ryan, R-Wisc., once called a "convoluted legislative charade" when Democrats were considering passing full health care reform using the reconciliation process.

The key to using this process is that repealing parts of the bill that impact the deficit, including taxes and mandatory spending which includes funding for programs like Medicare and Medicaid, could be done with just a simple majority of 51 votes. Republicans say that the Supreme Court's ruling that the penalty for not buying health insurance amounts to a tax greases the wheels for repeal through reconciliation. The process can be long and complex as the Congressional Research Service lays out.

In a nutshell, Congress would pass its annual budget including specific instructions to congressional committees to write repeal legislation related to parts of the health care law that impact the deficit. Once the bills pass through the committees with jurisdiction over parts of the health care law, the bills would likely be packaged together by the House and Senate budget committees. Those committees then vote on whether to report the reconciliation package to the House or Senate. Once the reconciliation package hits the Senate floor, it's on the fast track. Reconciliation bills only get 20 hours of debate at the most. The House would also likely limit the debate time. The only barrier for Republicans at that point would be the parliamentarian who would determine, line by line, which provisions can be considered under reconciliation and which ones cannot.

Any differences between the House and Senate reconciliation packages would then need to be worked out and the final package would have to pass both chambers again. Mix, stir and you get health care repeal.

There's just one problem for Republicans and the bill's opponents. Reconciliation would not repeal the entire law. It clearly could cover the heart of the bill, the individual mandate, since the penalty for not buying insurance would impact the deficit. But regulations included in the bill would likely stay in place and need 60 votes for repeal since they don't directly impact the deficit or spending. This could leave the law gutted, but also leave insurance companies with a lot of new rules requiring they cover more of the sick, and provide better coverage to all, without a guarantee of new customers required o buy insurance to offset their new costs.

Republicans say they would solve such problems by replacing parts of the health care bill with their own legislation "step by step," but have said little about which parts of the Democrat's bill they would put back in place in the future.

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