Following Tuesday’s midterm elections, both parties have indicated that they wanted to re-visit the Affordable Care Act, but the skeptic in me doesn’t think that they’ll agree on anything beyond the 1099-reporting requirement and even that holds its own difficulties. Assuming of course, that repeal is a non-starter — The Hill’s Mike Lillis reported earlier today that Sen. Tom Harkin (D-IA) reiterated that the effort would go nowhere in the Senate — what other health initiatives will the new Congress consider?

Health care industry and employer lobbyists who, in anticipation of the midterm wave, have shifted their campaign contributions to Republicans this election cycle, may provide some clues to what lawmakers are hearing about the affects of reform and other health priorities. And so what follows is only a partial list of their concerns and demands:

PHARMACEUTICAL INDUSTRY: The industry doesn’t expect Republicans to reopen the doughnut hole, but it does want Congress to “reauthorize the Prescription Drug User Fee Act, or PDUFA, which allows companies to pay fees to the Food and Drug Administration to accelerate product reviews.”

LARGE EMPLOYERS: “They don’t want to repeal it,” said Geoff Manville, principal in Mercer’s Washington Resource Group. “But large employers for their part want to amend the law and make changes, largely around provider payments and delivery-system reform.” Big employers “would like to see more aggressive pay-for-performance measures that aim to improve patients’ health results while reducing costs in the Medicare program, he said. “That’s the 800-pound gorilla that drives the entire health-care system.”

INSURERS: “The insurance industry is working to persuade the next Congress to roll back a roughly $70 billion tax on insurance companies that takes effect in 2014, saying it will disproportionately hit small businesses that insure their workers. It also wants lawmakers to allow insurers to widen the rating bands that dictate how much more insurers can charge older customers. Insurers also want to tackle the growth of health costs by enacting a new measure to give robust protections against medical malpractice lawsuits to doctors who follow certain “best practice” guidelines.”

HOSPITALS: The American Hospital Association formally came out “in support of Sen. Cornyn’s bill to repeal reform’s Independent Payment Advisory Board (IPAB).” “America’s hospitals support the repeal of IPAB because its existence permanently removes Congress from the decision-making process and threatens the long-time, open and important dialogue between hospitals and their elected officials about the needs of local hospitals and how to provide the highest quality care to their patients and communities,” they wrote in a letter.

DOCTORS: “The American Medical Association (AMA) is warning of ‘a catastrophe’ if lawmakers don’t step in to block the 23 percent cut, which is scheduled to take effect Dec. 1, and another 6.5 percent cut that’s due a month later.”

I’ve chronicled the GOP’s early hints of dismantling the Affordable Care Act by challenging the law’s regulations, but Senate Minority Leader Mitch McConnell’s reference to the tactic in today’s address solidifies this as a serious GOP repeal strategy, and as such it deserves some additional consideration.

As far as I can tell, Congressional oversight of rule-making began with the Congressional Review Act of 1996, which allows Congress to review and reject both past and present federal regulations. Before a rule can take effect as a final rule, the law stipulates that the Federal agency issuing the regulation must submit to each House of Congress and the Comptroller General a report containing a copy of the rule and a proposed effective date. The specific details of this strategy are below (courtesy of the Congressional Research Service) but the gist is that if both houses pass the disapproval resolution and the President does not veto it, the resolution becomes law, and the rule becomes “of no force and effect”:

For initial floor consideration, the Act provides an expedited procedure only in the Senate. (The House would likely consider the measure pursuant to a special rule.) The Senate may use the procedure for 60 days of session after the agency transmits the rule to Congress. In both houses, however, to qualify for expedited consideration, a disapproval resolution must be submitted within 60 days after Congress receives the rule, exclusive of recess periods. Pending action on a disapproval resolution, the rule may go into effect, unless it is a “major rule” on which the President or issuing agency does not waive a delay period of 60 calendar days.

If a disapproval resolution is enacted, the rule may not take effect and the agency may issue no substantially similar rule without subsequent statutory authorization. If a rule is disapproved after going into effect, it is “treated as though [it] had never taken effect.” If either house rejects a disapproval resolution, the rule may take effect at once. If the President vetoes the resolution, the rule may not take effect for 30 days of session thereafter, unless the House or Senate votes to sustain the veto. If a session of Congress adjourns sine die less than 60 days of session after receiving a rule, the full 60-day periods for action begin anew on the 15th day of session after the next session convenes.

Congress has only invoked this prerogative only once, in 2001 when President Bush signed into law “a repeal of Clinton administration regulations that set new workplace ergonomic rules to combat repetitive stress injuries.” Democrats considered using the technique to reverse President Bush’s environmental regulations once Obama came to power, but never did.

For Republicans, this too will be an uphill climb, but many Tea Party conservatives seem energized at the possibility of taking down unpopular regulations. As incoming Senator Rand Paul (R-KY) told CNN several days ago, “I think we should sunset all regulations unless they’re approved by Congress. That doesn’t mean we won’t have regulations, it just means that Congress should be approving the regulations and you shouldn’t have unelected bureaucrats making regulations.”

This morning, after laying out the Republican strategy for repealing the Affordable Care Act, Senate Minority Leader Mitch McConnell (R-KY) argued that Republicans stood with the American people and urged the administration to follow suit. “The formula is simple, really: when the administration agrees with the American people, we will agree with the administration,” McConnell said in the speech titled “Listening To The People Who Sent Us Here.” “When it disagrees with the American people, we won’t”:

MCCONNELL: But whether or not the administration has a mid-course correction, Republicans have a plan for following through on the wishes of the American people. It starts with gratitude and a certain humility for the task we’ve been handed. It means sticking ever more closely to the conservative principles that got us here. It means learning the lessons of history. And, above all, it means listening to the people who sent us here. If we do all this, we will finish the job.

But McConnell has already broken “the formula” and his pledge to listen to Americans. Exit polls don’t suggest that a majority of Americans support repealing the health law and neither does regular polling. National exit polls reveal that neither party has a mandate on the issue, with 48 percent of Americans saying they want to repeal the law, and 47 percent saying it should be kept in place or expanded.

In most national opinion polls, support for repealing the law is a mile wide but an inch deep. For instance, a recent New York Times survey found that 41% of Americans thought Republicans should repeal the law, but that number dropped to 25% when the respondent was told that “repealing the law meant that insurance companies were no longer required to cover people with existing medical conditions.” Also, 46 percent of respondents also said that “the Democratic party is more likely to improve the health care system,” while just 28 percent thought Republicans were. An earlier poll similarly found that while 40 percent of respondents said they supported repealing the Affordable Care Act, “more than half changed their minds (leaving just 19 percent in favor of repeal) when pollsters mentioned that it’d mean letting insurance companies exclude people with pre-existing conditions.”

Indeed, as I’ve argued here, opposition for the law increased during the election cycle was because Americans were exposed to false advertising about the health law. “Opponents of the legislation, including independent groups, have spent $108 million since March to advertise against it” — “six times more than supporters have spent, including $5.1 million by the Department of Health and Human Services to promote the new law.” That $108 million went to finance the false claims that individuals who don’t purchase coverage will go to jail, or sex offenders will have access to government subsidized Viagra and seniors will lose all their Medicare benefits.

During an appearance on MSNBC this morning, incoming Pennsylvania Senator Pat Toomey similarly dismissed the polls and suggested that Republicans should pursue the repeal strategy. But in his home state, a majority wanted to leave the plan alone or expand it.” Just 45 percent supported repeal.

Senate Minority Leader Mitch McConnell (R-KY) brushed aside President Obama’s offer to work in a bipartisan manner to tweak or modify parts of the Affordable Care Act this morning, doubling down on the party’s commitment to repeal the law in its entirety. McConnell laid out what could be described as a three-pronged approach for rescinding the law: (1) Senate Republicans will “propose and vote on straight repeal, repeatedly,” and (2) hold votes “against its most egregious provisions,” (3) while House Republicans will work “on denying funds for implementation.” He admitted that “straight repeal” was unlikely, given Democratic control of the Senate and the White House, but promised to use oversight to hold administration officials accountable. “[O]versight will play crucial role in Republican efforts going forward,” McConnell said. “We may not be able to bring a repeal within the next two years and we may not win every vote against targeted provisions…But we can compel administration officials to defend this indefensible health spending bill and other costly government measures like the stimulus and financial reform.”

Ironically, McConnell’s plan to repeal the health law — in part or in whole — would have the effect of increasing the deficit and government spending, undermining what he described as the voters’ top priorities:

QUESTION: What do you think right now is the top priority for people out there? What do you think the people who voted this wave of conservatives want done first?

MCCONNELL: I think people are interested in spending, debt, and private sector job creation. They have taken a look at the affect of borrowing money from foreigners that will have to be paid back by our children and grandchildren and what kind of an impact that had on job creation. They don’t see much evidence of it…. So spending, debt, job creation in the private sector are the things I think Americans are significantly upset about and I think was at the root of the electoral success that my party had last Tuesday.

Watch a compilation:

According to the Congressional Budget Office (CBO), repealing the entire health care bill would add $140 billion deficit and it would also reverse the course of health care spending. Similarly, the Center for Medicare and Medicaid (CMS) estimates that Medicare spending will decline $86.4 billion from previous projections due to reforms — meaning that it will increase if reform is repealed repealed.

Significantly, the GOP’s ‘replacement proposals’ likely won’t do enough to reverse this trend. The CBO has estimated that the GOP’s health plan in the House — presented by House Minority Leader John Boehner (R-OH) as an alternative to the health care bill — would increase the number of uninsured to 52 million in 2019 and reduce the deficit by only $68 billion over the 2010–2019 period.