Obama's Victory Paves Way for Continued ACA Implementation

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President Obama's victory in Tuesday's election removes the possibility that the Affordable Care Act will be completely repealed, Reuters reports. However, observers note that challenges to implementing the law still remain.

Throughout the campaign, Obama's challenger, former Massachusetts Gov. Mitt Romney (R), repeatedly vowed to repeal the ACA (Morgan/Yukhananov, Reuters, 11/7). However, with Democrats maintaining their majority in the Senate and Obama winning, opponents of the ACA will face long odds to repeal. As a result, industry experts say Obama's victory represents an affirmation of the law in the face of opposition, according to Modern Healthcare (Zigmond/Daly, Modern Healthcare, 11/7).

Chris Jennings, a health care adviser to President Clinton, said, "There's sort of an immediate acceptance that this law will stay in place in some meaningful way. It's sort of like a big barrier has been removed" (Reuters, 11/7). Rep. Phil Gingrey (R-Ga.) in July said an Obama victory would mean the ACA "sinks in, it gets roots, and it ain't going away."

However, some Republican governors have continued to say they will not enact key components of the law. Several Republican-led states have said that they will not set up health insurance exchanges called for under the law and that they will not participate in the ACA's Medicaid expansion -- moves that could strain the federal budget (Baker, "Healthwatch," The Hill, 11/6).

According to Bloomberg, Obama's victory means implementation of the ACA will move forward in all 50 states, "with or without the cooperation of their governors." States face immediate pressure to make decisions regarding the law, starting with whether to run their own insurance exchanges. The deadline for states to decide whether to allow the federal government to run their exchange is Nov. 16 (Wayne, Bloomberg, 11/7).

Meanwhile, congressional Republicans still are expected to push back against the law -- such as working toward delaying or scaling back the ACA's Medicaid expansion -- during deficit talks later this month (Reuters, 11/7). Kaiser Health News notes that Republicans maintained control of the House, which means they could "still use its purse-string power" to inhibit implementation (Hancock, Kaiser Health News, 11/7).

According to Julius Hobson, a former lobbyist with the American Medical Association, efforts to defund the law might be limited because a majority of the ACA's major provisions already received funding approval as part of the law's enactment.

However, Republicans still might use any implementation problems with the law as evidence that it should be repealed or delayed as they seek to gain more seats in Congress in the 2014 mid-term elections (Modern Healthcare, 11/7).

Raft of ACA Regulations Ahead

In related news, the Obama administration this week is expected to begin issuing a backlog of rules and regulations regarding ACA implementation, National Journal reports.

  • Rules that likely will be issued in coming months will address:
  • Health insurance exchanges;
  • Essential health benefits requirements;
  • Minimum employer coverage requirements; and
  • Medicaid pay increases for primary care providers (Sanger-Katz, National Journal, 11/6).

In addition, the administration has yet to issue final regulations on the definitions of "part-time" and "full-time" workers with regards to the penalties that would be levied on employers that do not provide affordable coverage options. The administration also has not released final rules on how certain religious employers would be able to avoid the contraceptive coverage requirements under the ACA.

HHS could begin releasing the backlog of directives and regulations as soon as Wednesday (California Healthline, 11/5).

Exit Polls Indicate Health Care Factored Into Voters' Decisions

Although the economy and unemployment were the "central focus" of voters in Tuesday's election, they also factored health care into their decisions, according to exit polls, the Wall Street Journal reports (King, Wall Street Journal, 11/6).

Health care was the most important election issue for 17% of voters, according to a poll conducted for a group of news outlets (Viebeck, "Healthwatch," The Hill, 11/6).

Meanwhile, voters remained split over the ACA (Wall Street Journal, 11/6). About 47% of voters said the ACA should be maintained or expanded, compared with 45% who said the law should be partially or completely repealed (Schultheis, Politico, 11/6).

The exit polls included 60,000 voters at about 350 locations around the U.S. (Schultheis, Politico, 11/7).

Medicare, SGR Must Be Addressed Quickly

In the wake of Obama's victory, the Obama administration likely will have to act immediately to avoid mandated spending cuts under sequestration -- including cuts to Medicare provider payments, the Wall Street Journal reports (Paletta, Wall Street Journal, 11/6).

Since a 12-member panel created by the 2011 Budget Control Act failed to reach a deal on at least $1.2 trillion in spending cuts, billions of dollars in automatic cuts -- known as sequestration -- were triggered, including a maximum 2% reduction in Medicare spending over 10 years (California Healthline, 9/17).

Meanwhile, the administration also is expected to quickly address a 27% reduction to Medicare physician reimbursement rates, which is scheduled to take effect on Jan. 1, 2013 (Sherman/Raju, Politico, 11/7).

White House and congressional officials previously have said both the 2% reduction to all Medicare reimbursement rates under the sequester and a 27% cut to Medicare physician reimbursement rates are unlikely to happen because Congress will intercede in time (California Healthline, 11/6).


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