- Although the Affordable Care Act passed in 2010, it won't be fully in place until 2014
- Obama administration officials will be in charge during the law's full implementation
- There's a backlog of new regulations that are expected to be unveiled soon
Liberals feared that a Mitt Romney presidency could mean the end of the most significant piece of social legislation in half a century.
Conservatives feared a second Obama term would allow implementation of another massive entitlement program.
But for hospital administrators and businesses like health insurance companies and drug makers, the biggest fear on election night was that they would be left with an enormous mess to clean up.
Although the Affordable Care Act, passed in 2010, won't be fully in place until 2014, billions of dollars have already been distributed and the wheels of reform have begun to turn.
Seniors with Medicare prescription drug coverage are getting cash rebates. Young adults have joined their parents' insurance policies. Uninsured Americans with pre-existing conditions are getting health coverage through Obamacare programs. Some states are setting up health insurance consumer assistance bureaus and drawing up the architecture for new exchanges where private health insurance will be sold and regulated.
Stopping all of that, which Romney vowed to do if not by edict then by throwing truckloads of sand in the government's regulatory gears, would have created chaos.
The ability of critics to challenge the law's legitimacy was drastically reduced with the Supreme Court upholding its constitutionality earlier this year. But it is also important that Obama administration officials will be in charge during the law's full implementation. Hospitals, insurers, drug companies and patients can now expect a more orderly rollout of the Affordable Care Act over the next few years.
As Jennifer Haberkorn reported in Politico last week, the Obama administration recently reduced the flow of new regulations defining precisely how the legislative language of Obamacare would work in practice. The purpose of holding back new rules was to avoid controversy close to the election.
As Haberkorn reported, there's now a backlog of new regulations that are expected to be unveiled soon, including some that could affect wide swaths of the population. We still don't know, for example, what health services and expenses insurers will be required to cover under Obamacare.
At the same time, governors will soon decide whether to set up their own health insurance marketplaces to regulate individual and small business health plans. Many Republican governors had held off making this call until after the election. States that opt not to set up exchanges will open the door for the federal government to run them instead.
Thanks to a part of the Supreme Court Obamacare ruling that left the law's large Medicaid expansion as optional instead of mandatory for states, governors and state legislatures will also have to decide whether to widen eligibility for the public insurance program.
(Here's a reliable timeline of Obamacare provisions and when they are scheduled to go into effect.)
As Phil Galewitz reported for Kaiser Health News, some state-based Republicans may be persuaded to get on board with such pieces of the law now that it's definitely staying on the books:
"Mike Fasano, a Republican and one of the longest serving Florida lawmakers, said with the president's win, the GOP-dominated state legislature would 'take a hard look' at expanding Medicaid — despite the opposition of Republican Gov. Rick Scott.
"Fasano, who is moving from the state Senate to the state House next year, said Florida can't afford to miss out on new revenue without having its own plan to help more than 4 million residents who lack health insurance. He acknowledged that challenging Scott would be an uphill battle but said the governor's waning popularity might embolden lawmakers."
Despite the Affordable Care Act's more certain future under an Obama second term, controversy over the law isn't over. The public is still largely split on its merits. Republican state lawmakers and governors won't suddenly and universally back the law. Republicans in Congress still have say over funding for some of its programs.
But the health care industry is now free from a great deal of uncertainty. Or at least it's free from this round of uncertainty. Any policy, business sector or law that's tangled up with politics will always retain a tinge of the unknown. See here.