After nearly three years of legal and political threats that kept President Obama’s health care law in a constant state of uncertainty, his re-election on Tuesday all but guarantees that the historic legislation will survive.
Now comes another big hurdle: making it work.
States will need to hustle to put in place the various pieces meant to help their residents meet the contentious requirement of having health insurance by Jan. 1, 2014. The federal government is under immense pressure to provide more guidance, while building its own tools to ensure the law’s success.
With Mitt Romney’s vow to “repeal and replace” the law no longer a threat, its supporters are exulting. Bill Foster, a Democrat elected to the House from a suburban Chicago district, summarized the message of the election this way: “For our district and for our country, the debate on Obamacare is over.’
But Mr. Obama and his allies must now step up efforts to promote and explain it to a public that remains sharply divided and confused about it. In exit polls on Tuesday, nearly half of voters said the law should be either partially or fully repealed..
“There is still a tremendous amount of disinformation out there,” said Jeff Goldsmith, a health industry analyst based in Virginia. “If you actually are going to implement this law, people need to know what’s in it – not just the puppies-and-ice-cream parts, but ‘Here are the broader social changes intended and how they can help you.'”
The health care overhaul still faces resistance from many Republican members of Congress, governors and state legislators. In the 11 weeks before Inauguration Day, Mr. Obama faces crucial choices about strategy that could determine the success of the law in the next few years: Will the administration, for example, try to address the concerns of insurers, employers and some consumer groups who worry that the law’s requirements could increase premiums? Or will it insist on the stringent standards favored by liberal policy advocates inside and outside the government?
Much now depends on the states, where lawmakers will decide in the coming weeks and months whether to build online marketplaces known as insurance exchanges, where individuals and small businesses can shop for health plans, and whether to expand their Medicaid programs to reach many more low-income people.
The clock is ticking on the exchange question in particular: states have until Nov. 16 to decide whether they will build their own exchange or let the federal government run one for them.
So far, only about 15 states and the District of Columbia have created the framework for exchanges through legislation or executive orders; three others have committed to running exchanges in partnership with the federal government. A number of Republican governors, including those in Arizona, Idaho, New Jersey, Virginia and Tennessee, had said they would decide after the election, giving themselves only a 10-day window before the deadline.
“I would expect that starting today there are a significant number of fascinating conversations going on behind closed doors in state capitols all over America,” said John McDonough, a professor of public health at Harvard who helped draft the law.
State efforts to carry out the new law will coincide with epic negotiations between Mr. Obama and Congress over federal spending and taxes.
Some observers believe that costly provisions of the health care law, like federal subsidies to help families with incomes up to 400 percent of the poverty level pay their insurance premiums, could be scaled back in the name of deficit reduction.
“We know folks on the Hill are talking about this already,” said David Smith, an analyst at Leavitt Partners, a consulting firm that advises states on the law. “There are a lot of competing factors, but they have to find the savings and we believe health care will be one of the places where they will go.”
States Face Tight Health Care Deadlines
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States Face Tight Health Care Deadlines
