After playing defense for the last two years, Obama now has to follow through by clarifying all of the uncertainty that looms over the Affordable Care Act. There are a lot of gaping holes particularly in the politicking that is happening now since Republicans are no longer assured of a Romney-repeal. State leaders have only about a week to decide whether to comply with state run insurance exchanges. The Obama administration has to budget for the federal-run exchanges where states opt out and they also have to prepare for open enrollment which starts October 1, 2013 for 2014 eligibility. All of this has to get done per the set-forth legal deadlines, not to mention that Republicans in Congress are already using delay tactics and last minute legal-loophole-finding to challenge the constitutionality of the mandates. It’s more than daunting for a President who has the threat of a teetering economy, Afghanistan and Sandy as he approaches his second term. And it’s not lost anyone that this President has a lot to prove. But is Obama prepared to walk the walk after talking huge reform for the past two years? He only has 11 months before a nation of citizens begins signing up for the plan. But there are obstacles here that while he has thus far been a true champion of this plan, surely even he would admit, exist.
First and foremost, if Republicans do bring forth challenges—and many have not been shy about threatening legal action pending the election results–the weight of so much litigation could cripple the current administration from moving forward. This is most definitely a fact not lost on Republican opponents. If enough Republicans opposing the mandates—as well as the idea of the state run exchanges–get together, the sheer Power in numbers could be devastating to an administration trying to balance a budget, even if the challenges are simply litigious in nature. Also with such a very fragile economy and a Republican majority in the House, could there be talks of eliminating certain portions of the Affordable Care Act especially in light of the fact that so few states are complying at this point? It’s possible. However, equally as likely is the fact that many state leaders may have waited until the last minute, simply choosing instead to make a decision pending election results.
In an article by the Associated Press, Andrew Hyman of the nonpartisan Robert Wood Johnson Foundation, states, “The clarity brought about by the election is critical. We are still going to be struggling through the politics, and there are important policy hurdles and logistical challenges. But we are on a very positive trajectory.”
One factor in that positive trajectory as the administration moves forward with the ACA, Human and Health and Services Secretary Kathleen Sebelius has decided to stay on until the law is fully enacted. “I can’t imagine walking out the door in the middle of that,” she said to The Kansas City Star during the Democratic convention.
With over 30 million uninsured people expected to gain coverage under the Affordable Care Act and many uninsured low income families looking to be covered through an expansion of Medicaid, the sheer weight of carrying out the ACA, is palpable. State-level challenges to the federal law will most assuredly continue to be filed in court. And on the Hill, Republicans claim that if the budget means tax increases then it must also mean cuts to health care or delays in implementation.
But if Congress decides to compromise because of budget concerns, thereby scaling back on portions of the Affordable Care Act, how will President Obama face the American people, many of whom voted him in on health care reform alone?