Romney has pledged to grant states waivers from Obama's health-care reform law on Day 1 as president, and to work with Congress to try to repeal and replace the law. That’s why keeping a GOP majority in the House and taking over the Senate are critical to repeal. With 50 seats in the Senate, Republicans can use a fast-track budget process known as “reconciliation” to repeal the law, avoiding the need to line up 60 votes to end a filibuster. (Should Romney win, Paul Ryan, as vice president and president of the Senate, would be empowered to break tie votes, thus allowing a unified GOP caucus to repeal the law even in an evenly split Senate.)
Obama is counting on implementation to help win over skeptics and build public support for the law, but the law does not go into full effect until 2014. Come January, if Republicans control both houses of Congress but Obama is still president, repeal legislation may cross his desk. He would veto it, sending it back to Capitol Hill, where Republicans can attempt to override. Two-thirds majorities of both houses are required – an extreme long shot.
After the US Supreme Court upheld the health-care law in June, the president said he would “work with anybody who wants to work with me” to improve the law, but he offered no suggestions. Obama advisers say the idea of improving the law appeals to independent voters.