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Obama’s win means healthcare reform will proceed


The re-election of President Barack Obama, coupled with a continued Democratic majority in the Senate, sets the path for the future of healthcare in the United States.

The Obama administration is expected to continue with preparations for key provisions of the Affordable Care Act, such as the individual mandate to buy healthcare insurance, the establishment of exchanges in each state for individuals to purchase insurance and the expansion of Medicaid to cover more Americans.

Former Massachusetts Gov. Mitt Romney had pledged to seek repeal of the ACA if he won the election, although he had spoken of retaining certain popular provisions.

Instead, the core measures are expected to take effect at the start of 2014. The mandate and expansion of Medicaid eligibility are projected to provide coverage for 30 million uninsured people by 2022.

Elements that are designed to partially change the way healthcare is provided in the U.S. will go forward as well. Examples include value-based purchasing in Medicare ( and Accountable Care Organizations (

The American Nurses Association, which backed healthcare reform and endorsed Obama, stated it looks forward to supporting the administration’s effort to implement the ACA, “a transformative law that will ultimately provide millions of Americans access to quality, affordable healthcare.”

“President Obama believes, like we do, that healthcare is a right, not a privilege,” ANA President Karen A. Daley, RN, PhD, MPH, FAAN, said in a news release. “We are excited to continue working with his administration to ensure that patients have access to quality, affordable healthcare, including access to a full range of nursing services.”

The election was this year’s second potential obstacle to implementation of Obama’s vision of healthcare reform. The Supreme Court upheld the constitutionality of the ACA by a 5-4 vote in late June.

The Republican-controlled House of Representatives still may have something to say about the details of ACA. Negotiations over the next two months regarding budget cuts could include discussion about the cost of the expanded Medicaid program.

For that matter, any ACA provision related to future expenditures — such as subsidies to bolster the number of primary care clinicians and provide free preventive care — may be on the table during budget talks. A possible effort to reduce subsidies for people in certain income ranges to buy insurance could limit access to healthcare coverage.

At the state level, some governors have expressed a reluctance to expand Medicaid as called for by the ACA, meaning some uninsured people in those states may continue to lack access.

Some states also have made little or no progress on setting up health insurance exchanges, in which people can shop for policies if they do not have health insurance through an employer, but the Department of Health and Human Services has said it will establish and operate exchanges in any state that needs help.

Meanwhile, Medicare and Medicaid are unlikely to change anywhere near as substantially as they would have with a victory by Romney, whose vice presidential nominee, Rep. Paul Ryan, was the author of plans to significantly remake the two programs.

Ryan proposed turning Medicare into a voucher program beginning in 10 years, with the government paying seniors a certain amount to buy coverage. He endorsed taking the federal government out of Medicaid policymaking virtually altogether, instead providing block grants to states to run the program.

Changes to Medicare still could lie ahead. During negotiations over the federal budget deficit in the summer of 2011, Obama reportedly was open to incrementally raising the program’s eligibility age in return for Republicans’ agreement to raise taxes on the wealthy.

“While all these changes are taking place, we’ve got to make sure that America’s healthcare system is run as effectively and as efficiently as possible,” said Ron Pollack, executive director of Families USA, a nonprofit advocacy group for healthcare consumers. “Clearly we’ve got to make sure that people get care on a timely basis, and that we don’t pay for care based on volume of services, but on the quality of services that people should receive. That is the key agenda that all of us need to pursue in the months and years ahead.”

For more coverage of the healthcare issues surrounding this year’s presidential election, see’s special election page at

Editor’s note: does not endorse political candidates or positions.


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