Obama win ensures health law's future

“ObamaCare” is here to stay.

President Obama’s projected victory Tuesday night, coupled with Democrats’ continued majority in the Senate, ensures that the Affordable Care Act will not be repealed, and will be implemented as aggressively as possible.

Obstacles for the law still remain — Republican governors have vowed not to implement key provisions, and congressional Republicans could have some success chipping away at federal implementation funding.

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But getting rid of the entire law now seems permanently out of reach for Republicans, who have previously acknowledged that Election Day represented the last chance to stop “ObamaCare” from taking effect.

“This train is leaving the station, and there’s not going to be another opportunity,” Rep. Phil Gingrey (R-Ga.) said in July. “If Barack Obama is reelected to a second term, and we don’t replace him with the 45th president, then this law sinks in, it gets roots, and it ain’t going away.”

All eyes will now turn to the states, which pose the biggest threat of any real damage to the Affordable Care Act. Only 16 states have created exchanges, the new insurance marketplaces that are supposed to be up and running in every state by Jan. 1, 2014.

The Obama administration has given states a Nov. 16 deadline to decide whether they plan to create their own exchanges or leave the task to the federal government, meaning there’s little time left for Republican governors who were avoiding the issue in the hopes of a Romney victory.

Several GOP-led states have said that in addition to not setting up an exchange, they plan to opt out of the healthcare law’s Medicaid expansion. Republican governors can strain the federal budget by forgoing state-run exchanges, and sitting out the Medicaid expansion would cut deeply into the healthcare law’s ability to cover the uninsured.

So, Republicans bent on making life difficult for “ObamaCare” still have some options, but their potential impact is waning as the law moves further ahead.

Obama’s reelection is the latest in an unbroken string of victories for supporters of the Affordable Care Act. For all the breathless narratives over the past three years about the law being at death’s door — and taking Obama’s political fortunes with it — both Obama and his signature domestic achievement have proven remarkably resilient.

In 2009 and 2010, Republicans hoped drawn-out congressional negotiations and town-hall rage would scuttle Obama’s healthcare plan, and that Scott Brown’s election in Massachusetts would put the nail in the coffin. The law still passed. Republicans roared into the House majority in 2011 vowing to defund the law. That also didn’t work. They pinned their hopes on the Supreme Court, confident it would overturn at least part of the law. The court upheld it. 

House Republicans can continue holding symbolic votes to repeal or defund the Affordable Care Act, like the 30-plus votes they held over the past two years. But polling shows that voters — particularly independents — are tired of the healthcare fight, even if they don’t necessarily like the healthcare law.

Had Romney won, the ACA would have been plunged into deep uncertainty, as his administration could have slow-walked or watered down parts of the implementation effort. But with Obama still in the White House, the Health and Human Services Department will continue on the path to full implementation just as aggressively as it has for the last three years.

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