NATIONAL HARBOR, Md. — Regardless of who wins the presidential election in November, or whether the Patient Protection and Affordable Care Act is fully implemented or systematically dismantled, keynote speakers at the American Society for Healthcare Risk Management's 2012 conference in National Harbor, Md., agreed that much of the work to bring about a lasting overhaul of the nation's health care system lies ahead.

During a pointed though markedly convivial discussion of Washington politics, health care delivery and the murky spaces lying between them, CNN contributor Paul Begala and MSNBC political analyst Michael Steele were asked to predict the fate of President Barack Obama's signature health care reform act depending on whether he or former Massachusetts Gov. Mitt Romney, prevail at the polls next month.

Both speakers agreed that plans for full implementation of the health reform law's core provisions likely would continue under a second Obama term, regardless of how the congressional elections play out. However, Mr. Steele, the former chairman of the Republican National Committee, offered a far more grave assessment of the consequences of that scenario than did Mr. Begala.

“They have no idea how they're going to pay for this legislation, and I promise you that we're only seeing the tip of the iceberg in terms of the cost,” Mr. Steele said. “If (Obama) gets re-elected and this thing does get fully implemented, is he prepared to deal with the explosion in the growth of government, in the creation of a whole new entitlement and a whole new level of bureaucracy that will not be undone?”

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Mr. Steele and Mr. Begala also agreed that the fate of the existing reform law is much more difficult to predict should voters deliver the White House to Mr. Romney, who has made clear his desire to repeal the legislation as written. Both speakers said Mr. Romney is unlikely to achieve a wholesale repeal of the reform law, as Republican lawmakers would likely need a congressional “supermajority” to pass a repeal vote through both the Senate and the House of Representatives.

“You're not going to come to Washington and, with the stroke of a pen, say to the nation, 'Guess what, we don't have Obamacare anymore,'” Mr. Steele said. “It doesn't work like that.”

Both Mr. Begala and Mr. Steele said it is far more likely that Mr. Romney will use a series of executive orders and waivers to effectively void the law's central provisions, though Mr. Begala was decidedly pessimistic as to how such action would affect health care providers, insurers and consumers.

“I do believe that you will see this law eviscerated in some way, probably in a rather clumsy way,” Mr. Begala said. “The truth is that (health care reform) is much more likely to be chaotic if Gov. Romney becomes President Romney, because he'll be under enormous political pressure to undo as much of the good, the bad and the ugly of Obamacare as possible.”

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That leaves the question of how Mr. Romney proposes to stabilize and, over time, reform the nation's health care systems. Throughout his campaign, Mr. Romney has made several variations of essentially the same promise: to eliminate the existing law and replace it with “patient-centered,” “market-driven” reforms, according to his campaign's website. What exactly those reforms would entail has remained largely undefined, the speakers said.

“When Mr. Romney has promised to repeal and replace the reform law, I've asked the question: 'Replace it with what?'” Mr. Steele said. “It's an honest, legitimate question.”

More recently, Mr. Romney has indicated that certain popular provisions of the law, including the ban on coverage exclusions based on a patient's pre-existing medical conditions, would be incorporated into his reform proposal. However, Mr. Begala said Mr. Romney has yet to provide much in the way of evidence to support the feasibility of his claim.

“You can't make insurance companies cover everybody, if you don't make everyone get into the pool,” Mr. Begala said. “Of course, he had an individual mandate in Massachusetts, so maybe he'll keep that, too. I don't know.”