President Obama’s reelection has major implications for health care reform, given that his opponent, former Massachusetts Gov. Mitt Romney, had pledged to file a bill to “repeal and replace” the Affordable Care Act (ACA) on his first day in office. With a democratically controlled Senate behind him, Obama should be able to move past the threat of repeal, according to Jean Sullivan, JD, director of the UMass Medical School Center for Health Law and Economics.
“It may not all go as planned, particularly since some parts of the law still need funding, but the threat of repeal is hollow now,” said Sullivan.
Key next steps under the ACA include the establishment of state-run exchanges—online shopping sites for health insurance—and then expanding Medicaid and providing subsidies for those who are poor but ineligible for the government-run program.
Some states, such as Texas and Florida, have rejected these ideas. The federal government can step in and build exchanges for the states that choose not to, but the question of expanding Medicaid became more complicated after the Supreme Court’s ruling on the matter. “The ACA required states to expand eligibility levels to any individual with income below 133% of the poverty level,” explained Bob Seifert, MPA, a principal associate at the Center for Health Law and Economics. “The Supreme Court ruled that they don’t have to do that.” (Related link: Sullivan on U.S. Supreme Court ACA ruling.)
Now that the election is decided, certain stakeholders are also leaping into action. One of those groups includes people managing Medicaid in states that want to expand the program, and reap generous government funds to do so. Another group comprises large employers with more than 50 employees who are mainly low-wage earners. “They may make decisions about the mix of part-time versus full-time employees they have,” Sullivan said. “This may be a result of ACA provisions, or just routine, cyclical business decision-making to lower employee benefit costs in general.”
Of course, there are also opportunities to tweak the law now. The day before the election, Politico reported that the Obama administration was preparing to release a slew of new rules and regulations around the ACA. The move was said to be in part due to the Nov. 16 deadline for states to decide whether or not they will implement a health insurance exchange.
While adjustments will help, a key factor in the law’s success is going to be helping the public understand the changes ahead and how they are impacted. “I don’t think average Americans understand the full range of implications for themselves,” said Sullivan. “And most of them do not realize that there is a direct connection between health reform and economic security.” These are often presented as competing concerns, she pointed out. “But having health insurance puts you in a better place economically, especially in protecting against the impact of a catastrophic health event,” she said.
Slowing health costs should be another priority. Here, Massachusetts may be a leader and a model. The state’s 2006 health reform law was a model for the ACA and was enacted while Romney was governor of the state. The state has also recently enacted a health cost control law and is pioneering the types of changes in care delivery and reimbursement that Sullivan and Seifert see as pivotal for cost control. “For example, what we are doing with those high need patients who are eligible for Medicaid and Medicare is going to be very important,” Seifert said. “Massachusetts is again at the forefront with reform.”
See the major milestones in the ACA.
This article is the first in a series that will examine the progress of national health care reform in the wake of the presidential election.
Medicaid expansion a significant part of Supreme Court’s ruling