President Obama's Victory Seen as Affirmation of Affordable Care Act

November 8, 2012 — President Obama's victory in Tuesday's election removes the possibility that the Affordable Care Act (PL 111-148) will be completely repealed, Reuters reports. However, observers note that challenges to implementing the law 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).

However, 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 (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/Nussbaum, Bloomberg, 11/7).

Meanwhile, congressional Republicans still are expected to push back against the law -- such as by 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 because Republicans maintained control of the House, 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 (Modern Healthcare, 11/7).

Release of More ACA Regulations Expected

In related news, the Obama administration this week is expected to begin issuing a backlog of rules and regulations implementing the ACA, 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 additional details about Medicaid reimbursement increases for primary care providers (Sanger-Katz, National Journal, 11/7).

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 that oppose contraception will be accommodated under the federal contraceptive coverage rules (Haberkorn, Politico, 11/5).