This week will bring the much-anticipated vote in the House of Representatives on whether to repeal President Barack Obama’s health care law. It is a vote that needs to happen—but it’s what comes after the vote that Republicans need to be ready to answer.

As a political matter, this week’s vote is clear-cut. It puts on the spot a host of Democrats who ran against Obama’s law, distanced themselves from their party’s anti-economic-growth legislation, and declared their independence from former Speaker Nancy Pelosi (D-CA). Will they keep their word and break with their party, or stay loyal and risk the wrath of voters in 2012?

We’ll see, but either way the repeal measure will go no farther than this vote—it will be pronounced dead on arrival in the Senate by a death panel of Majority Leader Harry Reid (D-NV) and his allies.

What next, then? All indications from Capitol Hill sources are that the House Republicans intend to attack Obamacare from all corners, combining efforts to defund portions of the program, amend the most unpopular parts of the law, and engage in oversight with extreme prejudice.

Yet in time this last option may prove to be the only one that’s actually workable within the limited power of the House. Defunding or amending the law are at best delaying tactics that do not solve the long-term problems of this unworkable legislation. The parts of Obamacare that require approved appropriations from Congress each year are overwhelmingly the least significant portions of the law, and already the Obama administration is taking steps to shield key agencies and newly created boards from being defunded.

Controversial creations such as the Independent Payment Advisory Board (IPAB), a chief rationing body of Obama’s system, are guaranteed to receive mandatory appropriations that Republicans cannot block. And as Health and Human Services Secretary Kathleen Sebelius announced last week, other agencies such as the Office of Consumer Information and Insurance Oversight (OCIIO) will be shifted to the Centers for Medicare & Medicaid Services (CMS)—a perfect example of how the White House plans to undertake a shell game with taxpayer dollars to protect its signature social policy.

The amending process poses similar problems. The law is a vast mash-up of several proposals with complex, interlocking, and counterintuitive elements. Tweaking or improving elements of this mess would be a waste of time and effort if the real aim is to scrap the whole thing. And even if every amendment proposed thus far passes the House, only one or two have a prayer of passing the Senate or being signed by the president.

Given that neither defunding nor amending is a workable long-term solution, Republicans should concentrate on thwarting implementation by exercising their oversight abilities to the fullest. HHS has already fallen far behind on a host of required elements of the law, and Republicans should find out why. A House committee could force reclusive CMS head Donald Berwick to answer a question or two about his intentions. And Secretary Sebelius’s use of her waiver power for unions and the administration’s other allies should be examined and brought into public discussion.

That brings us to the one legislative step Republicans can and should embrace. Under the current arrangement, the waiver power for Obamacare belongs entirely to Secretary Sebelius, who already has gained a reputation for letting such proposals for state-based innovation gather dust on her desk. Republicans should focus their efforts on passing a law reversing this power dynamic: Mandate that the Secretary shall approve the overwhelming number of state waivers by default, and for a significant time period.

These waivers would give states and the people within them freedom from a host of burdensome requirements for several years, kicking the issue down the road until after the 2012 presidential election, when Republicans hope to be able to pass a real repeal.

Republicans should not waste time tweaking or proposing small fixes of Obamacare. Only a full repeal will work. As the saying goes, you’ve got to nuke it from orbit. It’s the only way to be sure.

Benjamin Domenech ( is a research fellow at The Heartland Institute and managing editor of Health Care News.