President Obama wins reelection; challenges still loom for ACA


While many early accounts of last night’s party for President Barack Obama hail the news as a boon for the Affordable Care Act (ACA), once that excitement wears off, Americans will realize that it's just too early to tell whether the reelection will actually be fertilizer or formaldehyde for health reform.

Yes, the law remains just that: legislation that passed, survived a Supreme Court challenge and, as of today, is safe from GOP contender Mitt Romney’s campaign promises to repeal it entirely.

[See also: President's win is reprieve for 'Obamacare']

But there are still quite a few growing pains ahead for the ACA.

The same Republican party that voted to repeal the law more than 30 times in the two years since it passed in March 2010, for instance, has retained control of the House of Representatives and even though Democrats kept the Senate, the type of repeal vote that NPR dubbed symbolic is likely to continue. 

So perhaps it’s telling that Obama made mere mention of what many consider landmark legislation in his victory speech, telling the story of a father saying that the ACA spared his family from losing everything to pay for leukemia treatments for their eight-year old girl. A touching story, indeed, en route to shedding light on where his immediate attention will likely turn.

“You elected us to focus on your jobs, not ours," Obama told the crowd at Chicago’s McCormick Place, rattling off the list of priorities. "And in the coming weeks and months, I am looking forward to reaching out and working with leaders of both parties to meet the challenges we can only solve together. Reducing our deficit. Reforming our tax code. Fixing our immigration system. Freeing ourselves from foreign oil. We’ve got more work to do.”

[See also: SCOTUS: Individual mandate is a tax, constitutional]

That work begins, of course, with the looming fiscal cliff. That will require the type of cross-aisle bipartisan wrangling that sounds so good in speeches yet has plagued the president – including in the realm of health reform and ACA provisions such as health information exchanges, Medicaid expansion and potentially even the meaningful use program.

And state-level resistance to health information exchanges and Medicaid expansion have deeper roots.

Indeed the usual suspects of conservative, if not Tea Party, governors – from Florida, Georgia, Louisiana, Mississippi, South Carolina and Texas – maintain that they will not expand the number of citizens Medicaid covers. And one could argue that they are doing so to simply put politics ahead of policy, for their own gain.