President's win is reprieve for 'Obamacare'

President Barack Obama’s victory cements the Affordable Care Act, expanding coverage to millions but leaving weighty questions about how to pay for it and other care to be delivered to an increasingly unhealthy, aging population.

"The reelection of Obama and the Democrats holding the Senate will solidify the law in American history," said Len Nichols, a health economist at George Mason University who supports what both sides have come to call "Obamacare." "By 2016 you’ll see the vast majority of states with operational [insurance] exchanges and the Medicaid expansion, and we’ll be on a pathway to a more humane system."

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

Republican presidential candidate Mitt Romney had promised to repeal the act and replace it with something that would loosen government’s involvement in healthcare. Conservatives portrayed the law’s survival as limiting the freedom of patient and doctor and adding to a federal debt that recently exceeded $16 trillion.

"This is the single most important election on the federal government’s role in the healthcare sector in our history," said Michael Franc, vice president for government studies at the Heritage Foundation. An Obama victory, he said, "gives the federal government unprecedented control over this one-sixth of the economy. That’s a big deal."

Despite Romney’s loss, the Republican-controlled House of Representatives could still use its purse-string power to press for delays in implementing the act, analysts said.

Franc, Nichols and other health policy experts were interviewed about election scenarios before the results were known.

[See also: Healthcare reform causes sparks during presidential debate]

Obama won despite criticism that he chose the middle of a financial catastrophe to seek the biggest change to healthcare in nearly half a century. Although aspects of the Affordable Care Act receive high marks, polls show it is still deeply unpopular with many Americans.

The president’s first term was about getting a bitterly divided Congress to approve the legislation and then defending it against unexpectedly vigorous legal challenges. His second term will be about bringing the law to life. He referred to the act in his acceptance speech early Wednesday, referring to an Ohio family with an 8-year-old daughter "whose long battle with leukemia nearly cost the family everything, had it not been for health care reform passing just a few months before."

Analysts forecast coverage for as many as 30 million previously uninsured Americans even as economic pressures lead to fewer choices and higher cost-sharing for those already covered by private insurers and Medicare.

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