There are two health care-related sideshows playing out in Washington. One is  a semantic argument about whether the fine for not having health insurance under  Obamacare is a “penalty,” as the law’s author’s originally claimed, or  a “tax,” as Supreme Court Chief Justice John Roberts ruled last month.  The other is a House Republican attempt to immediately repeal the  health care law, which is scheduled to get another vote this week. Neither of  these debates has any consequence. In fact, they’re obscuring the real reasons  the Affordable Care Act’s future is still incredibly uncertain, even  after the High Court’s decision to uphold the law.

If Mitt Romney is elected President and Republicans emerge from this year’s  elections with majorities in both houses of Congress, most experts agree that  they could repeal huge swaths of the health care law via  reconciliation, the parliamentary process that allowed Democrats to  push health care reform over the finish line in 2010 without a supermajority in  the Senate. As Politico reports  (subscription required), GOP staffers on Capitol Hill are currently studying  exactly what pieces of the law could be subject to change through  reconciliation.

Congressional rules say the process can only be used for legislation that  affects the federal budget and lowers the deficit, but that applies to much of  the ACA. Subsidies created by the law to help low and middle-income Americans  buy insurance outside of work could be vulnerable, for instance, even if  Republicans can’t repeal the whole law, which the Congressional Budget Office  says reduces the deficit. The loss of those subsidies could seriously imperil  the affordability of insurance and the effort to pull currently uninsured  Americans into the coverage market.

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