President Barack Obama holds up a copy of his jobs plans booklet while speaking at a campaign rally in Byrd Park in Richmond, Va., Thursday, Oct. 25, 2012. (AP Photo/Steve Helber)

"Obamacare is the law of the land," House Speaker John Boehner (R-Ohio) told ABC News last week ... before reversing course within minutes and affirming that his goal remains to repeal the "job-killing" legislation.

Boehner's quick turnaround -- a "whip-flop," to borrow Micah Weinberg's popular neologism -- reflects Republicans' general reaction in the week since President Obama's re-election. Lacking executive authority and controlling only one house of Congress, the GOP's options to slow the Affordable Care Act's implementation have dramatically dwindled.

As a result, some of Obamacare's most ardent critics are accepting that the law will stand, despite issuing Cassandra-like pronouncements about our nation's long-term fate.

"Obamacare is here to stay ... [although it's] destined to be the last major entitlement," Avik Roy, a former health adviser to the Romney campaign, wrote in Forbes last week.

But Republicans can still work to derail Obamacare. Here's how.

Refuse To Opt Into Exchanges, Medicaid

Republican governors will lead 30 states next year, which gives the party tremendous influence over the next stage of ACA implementation -- essentially, whether states will create a state health insurance exchange or opt into the law's Medicaid expansion.

"Now is not the time to go wobbly," the Cato Institute's Michael Cannon exhorts conservatives in National Review.

"Obamacare is still harmful and unpopular ... if enough states [refuse to implement its provisions], Congress will have no choice but to reopen" the law, and the GOP's control of the House should allow the party to win concessions, according to Cannon.

As of Wednesday morning, about six states remained strongly opposed to the ACA's Medicaid expansion, and nearly a dozen states were balking at implementing a health exchange, ahead of a looming end-of-the-week deadline to declare intentions.

But that number of Obamacare holdouts may have just shrunk by one.

Florida Gov. Rick Scott (R) -- one of the earliest and most outspoken opponents of the ACA -- on Tuesday night said he's begun working toward implementation of the law.

Push for Scaled-Back Reforms>

The GOP may not be able to win outright repeal of Obamacare, but the party is beginning to maneuver in an attempt to roll back some of its key provisions.

One starting point is likely to be the Independent Payment Advisory Board -- which continues to be controversial given its role in cutting Medicare spending -- House Majority Leader Eric Cantor (R-Va.) wrote in a letter to his colleagues last week.

"If we successfully make the case" to repeal IPAB and other measures, according to Cantor, "there are some issues that I suspect Senator Reid will have a difficult time compelling his members to oppose outright."

Meanwhile, various taxes in the ACA -- which were intended to help pay for the law -- are coming under scrutiny, especially with deficit talks looming. As part of early negotiations, Republicans are currently targeting an excise tax on medical device manufacturers, which is expected to take effect in 2013, as well as a separate tax on high-income earners.

Let the Law Fail

The ACA will need to be fixed.

This isn't a political pronouncement as much as a policy certainty; over the years, Congress has come together to repeatedly tweak Medicare and Social Security.

And some cracks in the new law are already apparent. Experts are calling for changes to how Obamacare cuts provider reimbursement. The law's Pre-Existing Conditions Insurance Plan is well below enrollment estimates but well above its planned costs.

Meanwhile, the Supreme Court's decision to let states choose whether they'll participate in the ACA's Medicaid expansion has opened a new loophole: There's a chance that many poor Americans will make more than the federal poverty level, but too much to qualify for Medicaid.

In theory, Congress could work to come up with bipartisan patches to the law -- but continued, willful resistance from the GOP will make the necessary fixes hard.

Moving Forward

Taken together, Republicans' options to stop Obamacare are relatively limited in scope. Barring a major change in the political climate, the GOP will mostly rely on tactics to impede and slow the law, a far cry from the party's stated goal of repeal-and-replace.

And the broader energy, and urgency, to repeal Obamacare outright seems to be dying down. A Kaiser Family Foundation poll released on Tuesday found that only one-third of Americans support repealing the law, the lowest level since the poll began tracking the issue.

But with full implementation of the law still months and years away, we're not done talking about Obamacare.

"The reality of the economic and political situation means the core elements of the ACA remain very much in play," the Heritage Foundation's Stuart Butler wrote last week in the JAMA Forum.

"The Obama administration is arguing that the election means the ACA is a settled issue," Butler adds. "It is far from that."

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