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By Lisa Zamosky
WebMD Health News
Reviewed by Louise Chang, MD
President Barack Obama's victory in Tuesday's election ensures that the health reform law, the signature accomplishment of his first term, will move forward.
Throughout the campaign, Gov. Mitt Romney vowed to repeal and replace the law if he became president.
The law, also known as the Patient Protection and Affordable Care Act, will for the first time guarantee that all Americans have access to health insurance starting in 2014.
"The path is basically open for implementation," says Washington and Lee University law professor Timothy Jost.
Yet Obama's victory doesn't mean the path ahead is without roadblocks, says James Morone, professor of political science at Brown University.
Two main features of the law need funding from Congress to move forward. One is the health insurance exchanges. These are state-run online marketplaces where people can buy health insurance starting in 2014.
The other is an expansion of the Medicaid program. This part of the law would greatly expand the number of Americans who would qualify for coverage.
"The interesting part will be how Republicans respond. Will they continue to sue and deny funding? We could see a major political battle," Morone says.
This will no doubt lead to heated debate throughout the coming year, particularly given the pressure in Washington to reduce government spending. That debate will also be shaped in part by which party has control of the House and Senate for the next two years.
"Obviously we have some big fiscal realities to deal with, and that may result in some hard negotiations as to what the administration's priorities are," Jost says.
Addressing those realities may mean Obama will be forced to compromise on parts of the law, such as scaling back how much government money is available to help people buy insurance. He may also face pressure to reduce the Medicare budget, says David Lipschutz, policy attorney with the Center for Medicare Advocacy Inc.
"It's unlikely Medicare will be ignored in the debt and deficit debate. There could be Medicare changes made as a result of that," he says. Exactly what those changes would look like is not clear.
What will happen to the Medicaid expansion is also up for debate. Although the Supreme Court upheld most of the health reform law in its decision earlier this year, it did say that states have the option to decide if they want to participate in the Medicaid expansion. The expansion was intended to provide health insurance to an additional 17 million people nationwide.
In response, a number of states, including Florida, Louisiana, Georgia, Mississippi, South Carolina, and Texas, have said they would not expand their programs.
Morone says as time passes, however, states opposing Medicaid expansion are likely to change their minds.
"States will realize there is all this money coming in to insure a hard population at a great rate," he says.
For the exchanges, there's a long way to go and not a lot of time to do it. The online markets must be up and running by October 2013.
To date, only 15 states plus the District of Columbia have firm plans to set up their own exchanges. Under the law, the federal government will set up exchanges in states choosing not to create one of their own. States planning to run their own exchanges have a deadline of Nov. 16 -- just two weeks from now -- to submit their blueprints.
"It's possible to see delays," says Brad Burd, general counsel for the online health insurance portal GoHealth.
Regardless of the political battles ahead, health reform is expected to march on. "I think at this point every American and company involved in health insurance ... should assume [health care reform] will go forward," Burd says.
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