Republicans may have a hard time making good on their promises to kill the Affordable Care Act, according to Beth Mantz-Steindecker of Washington Analysis.

The most likely outcome is “a lot of noise, but little legislative enactment,” Mantz-Steindecker says. “In many cases, the current law’s market reforms, medical loss ratio policy, industry fees and Medicare cuts to insurers, hospitals and home health are unlikely to be rolled back either due to Democrat opposition [or] scarcity of offsets.”

Many of the Republicans that voters swept into office Tuesday – and some of the Democrats U.S. Capitolwho returned to office – said while campaigning that they would do what they could to revamp or repeal the “act,” which is really a 2-act legislative package that includes the Patient Protection and Affordable Care Act (PPACA).

Most components of the Affordable Care Act, such as provisions that would create health care technology and quality improvement programs and health care worker support programs, have attracted little negative attention, or criticisms based mainly on concerns about improving the way the provisions would be implemented.

Some of the health insurance system overhaul provisions, such as provisions that could require most individuals with incomes over a designated level to own health insurance or pay a penalty, and many employers over a minimum size to provide group health coverage or pay a penalty, have come under relentless attack.

Insurers, producer groups, employer groups also have concerns about provisions that would require health insurers and health plans to spend a minimum percentage of revenue on health care and quality improvement efforts; provisions that would encourage state regulators to take an active role in reviewing and approving health insurance rate increases; and provisions affecting the ability of health insurance agents and brokers to participate in a new health insurance exchange coverage distribution system.

Republicans appear to be on track to hold 242 of the 435 House seats, up from 178 seats before Tuesday. In the Senate, the number of Republicans could increase from 41 to as many as 48.

Supporters of most bills need at least 60 votes to get them through the Senate, and supporters also need to get the president’s signature or have the ability to override a veto by mustering a two-thirds majority in the Senate.

Mantz-Steindecker says a health reform repeal bill will probably be one of the first bills to pass

in the Republican-led House.

The House also seems likely to pass measures eliminating key components of the Affordable Care Act, such as the individual health insurance ownership mandate, and measures aimed at defunding the agencies in charge of implementing health reform, Mantz-Steindecker says.

“But, we expect any bill that would materially gut the Democrats’ landmark legislation is unlikely to muster sufficient Senate support or get past a veto by President Obama,” she says.

Measures with a better chance of becoming law may include legislation that would eliminate a broad new 1099 tax reporting requirement, exempt more people from the individual health insurance ownership mandate, and reduce the number of people who will be eligible for subsidized health insurance.

Mantz-Steindecker notes that, despite the Republican takeover in the House, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) “still have their rulemaking and regulatory powers.”

Mantz-Steindecker says she thinks “there will be few instances where defunding will occur and even then, health care reform won’t be gutted.”

But House committees are likely to haul HHS Secretary Kathleen Sebelius and other HHS officials, such as Joel Ario, up to Capitol Hill for hearings, Mantz-Steindecker says.

“Besides eating up time and resources that could help slow down implementation, it gives the GOP multiple opportunities to re-air opposition to health care reform and puts the administration on the defensive,” Mantz-Steindecker says.

- Allison Bell contributed information to this report.