I ran across this interesting article discussing the possible repeal of Obamacare or the Affordable Care Act. We constantly hear the drone of the Republican candidates for the presidential nomination that the “first” thing on their agenda is to repeal Obamacare.

First, what are the chances that this might happen? Bruce Japsen reviewed this possibility. A parade of healthcare experts from doctors and policymakers to insurance industry executives and Washington lobbyists are telling the nation’s health journalists this past weekend that they don’t believe Republican presidential candidates will make good on promises to dismantle the Affordable Care Act.

Attendees at the Association of Health Care Journalists annual conference in Cleveland are hearing testimony saying the law, now six years old, has bipartisan support in Congress for several key aspects, including value-based initiatives and the effort to move away from fee-for-service medicine. There’s little, if any, serious discussion among healthcare experts about the “repeal Obamacare” mantra that continues to be floated by Texas Sen. Ted Cruz or reality show host and businessman Donald Trump.

Peter Lee, executive director of California’s health benefit exchange known as “Covered California,” told health journalists Friday that many Republicans outside of the media and political “glare” tell him: “We cannot pull this thing back” in reference to the ACA.

No matter who is elected President, speakers including Lee are telling journalists here that there would no longer be a “personalized lightening rod of Obamacare,” as President Barack Obama’s second term ends in January 2017. That alone will dampen some of the enthusiasm for repealing the ACA once a new chief executive is in the White House.

More broadly, the Congress would still have to approve any changes to the law and gridlock remains in Washington and isn’t expected to go away next year even if the GOP would retain control of the U.S. House and U.S. Senate.

Health reforms under the health law are essentially too entrenched and many not part of the Presidential campaign and election year politics such as Medicare and private insurance payment forms under the law.

Marilyn Tavenner, president of America’s Health Insurance Plans, a trade group and lobby representing some of the nation’s largest health insurers including Anthem, Cigna and Humana said she hears from Republicans and Democrats who like accountable care organizations (ACOs).

Such relationships are critical as the Affordable Care Act, private insurance companies and self-insured employers increase their contracts with accountable care organizations (ACOs), which group providers of medical care together to care for a population of patients. If the group of providers under the ACO reduces costs over a year’s time, it shares in the savings with the insurance company.

Also, what would they substitute for Obamacare? I have listened to these “clowns” and have yet to hear a reasonable alternative to the ACA. Realize, that I still don’t like the ACA.

Second so, what would happen if Obamacare was repealed, say that there was a way? What would happen?

Julie Henry reviewed that possibility for us. No matter who becomes our next president, changes will be made to the Affordable Care Act (ACA). Democratic candidate Hillary Clinton has promised to repair the law and Bernie Sanders has plans to replace it with universal coverage. GOP candidates Donald Trump and Ted Cruz have both vowed to repeal the law. But will repeal really happen at this point? It’s possible, but not likely. Here’s why.

Since the ACA went into effect in 2010, 20 million people have gained insurance, many for the first time. And uninsured rates are at an all-time low. Repealing the law without a replacement would cause millions of people to lose their insurance, which would be a political nightmare.

With no other options for care, the millions of people who would no longer be insured would return to hospital emergency rooms. In an article in The Hill, former Rep. Bill Owens (D-NY) said, “This will result in tens of billions of dollars in uncompensated care being provided by our hospitals.” Prior to the enactment of Obamacare, uncompensated care provided by hospitals was in the $75 billion to $125 billion range.

Insurers would suffer revenue losses, which would result in increased premiums. They would also be pressured by hospitals for higher reimbursements to make up for the increased costs of uncompensated care.

“The chaos that would ensue in the healthcare system by repealing Obamacare is largely unimaginable, and I suspect not at all thought through by proponents of repeal legislation,” Owens said.

Just look at the budget considerations, repealing the ACA would add $137 billion to the deficit over the next 10 years.

According to Obamacare Facts, repealing the ACA would add $137 billion to the deficit over the next 10 years and result in as many as 24 million people being uninsured by 2024. Repealing the law could cost as much as $6.2 trillion over the next 75 years.

The logistics of repealing the law is also a daunting task not even considering the

political and budget ramifications notwithstanding, there are additional potential barriers to repealing the ACA. In order for Obamacare to be repealed, Republicans would have to gain control of the White House, the Senate and the House of Representatives. “Unless both houses of Congress and the executive branch are under GOP control, Democrats would be able to block any repeal effort – and the Obamacare trench warfare that’s taken place since Democrats lost control of Congress in January 2011 would continue,” John McDonough, professor of public health practice, Harvard University, said in an article in The Conversation.

McDonough said even if Republicans were able to gain control of the White House and Congress, Senate Democrats could filibuster any legislation to repeal Obamacare. Republicans would need 60 Senators to vote to close the filibuster, which McDonough believes is unlikely. “For this reason, even if they’re in the minority, Democrats could block any straight repeal legislation and compel Republicans to resort to another path,” he said.

Now, back to the important question, what if Republicans are successful in repealing Obamacare, it definitely won’t happen overnight. According to Obamacare Facts, some of the things that could disappear right away include the majority of the new benefits, rights and protections, including protections for people with preexisting conditions.

Also, realize the effect on the states budgetary problems. It will be up to state officials and Congress to help consumers who can’t afford health insurance if the Supreme Court strikes down health law subsidies for millions of Americans, Health and Human Services Secretary Sylvia Burwell.

“The critical decisions will sit with the Congress and states and governors to determine if those subsidies are available,” Burwell told the House Ways and Means Committee on Wednesday.

The secretary told Congress earlier this year that the administration has no authority to undo “massive damage” that would come if the court invalidates the subsidies in the online marketplaces, or exchanges, which the federal government operates in about three dozen states.

By the end of this month, the court is expected to issue a ruling in the case, King v. Burwell. More than 6 million people could lose those payments and many more residents could see their premiums increase because of the havoc the loss of subsidies would cause in the market.

The challengers argue that one clause in the law says those federal payments would be available to consumers only in states that run their own exchanges. But the administration has argued the legislative intent was to make subsidies available to customers in every state, regardless of how its exchange was established.

During Wednesday’s hearing, Republicans pressed Burwell to indicate what type of legislation President Barack Obama might sign to restore subsidies if the court rules for the challengers. Many Republican lawmakers have acknowledged that they would like to find a way to offer a temporary option to help consumers, but they have failed to coalesce around a specific proposal.

Burwell said while the administration would be open to considering alternatives that make health care more affordable and accessible, the president would not sign legislation from Sen. Ron Johnson, R-Wis. That bill would maintain the subsidies for current beneficiaries through August 2017 but repeal the health law’s requirements that most individuals get coverage, which larger businesses offer insurance to their workers or pay a penalty and that plans provide specific types of benefits.

“Something that repeals the Affordable Care Act is not something the president will sign,” Burwell said.

A recent report from the American Academy of Actuaries said some changes favored by Johnson and other Republicans, such as eliminating the individual mandate, “could threaten the viability” of the health insurance market for individual plans.

Echoing comments she made last week, Burwell said the administration will work with states to help mitigate the consequences for consumers if the Supreme Court ruled against federal subsidies.

The session was billed as a hearing on the HHS budget fiscal 2016 request, but it quickly veered to Republican attacks on the sweeping 2010 health law while Democrats rushed to defend it.

“Whatever the Supreme Court decides this month, I think the lesson is clear: Obamacare is busted. It just doesn’t work. And no quick fix can change this fact,” said Ways and Means Chairman Paul Ryan, R-Wis. “Its very linchpin — its central principle — is government control. That means higher prices, fewer choices, and lower quality.”

Rep. Sander Levin of Michigan, the panel’s ranking Democrat, replied in kind. “What’s busted,” he said, “is not the ACA but [Republican] attacks on it. Endless attacks. Never coming up with a single comprehensive alternative all these years. So you sit as armchair critics while millions of people have insurance who never had it before. You’re livid because it’s getting better.”

Really? We will discuss some of the mistakes and actual costs of the ACA in future posts.

But what I have been hinting at, maybe beating to death, is that the more likely scenario is that the law will be revised rather than repealed. In a blog post for The Health Care Blog, Paul Keckley said here to stay are the law’s fundamental shift toward provider sponsored risk, increased transparency, connectivity through information technologies, comparative effectiveness studies to discern what works best, and insurance reforms that hold companies accountable for business practices that are understood by all.

And thank you all who have responded and commented on last week’s post regarding the “important conversation.”