Transforming Health: President Obama's reelection and health care policy

Written by Megan Lello, witf Reporter and Producer | Nov 26, 2012 4:01 AM

(Carlisle) -- During this year’s presidential campaign, Republican candidate Mitt Romney often repeated a promise to work to repeal the Affordable Care Act

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The law does many things, such as guarantee coverage for people with pre-existing conditions and get rid of lifetime coverage caps on insurance.

But with Romney’s defeat and Democratic control of the U.S. Senate, calls to roll back the law often dubbed “Obamacare” have quieted down.

Jim Hoefler, a political science professor at Dickinson College in Carlisle, Cumberland County, says most key parts of the law are safe. "I'm not entirely sure that most or any parts of the law could've been revoked if Romney had been elected president, but he could've certainly slowed things down, so the act will continue on its path toward full implementation by 2014."

Hoefler says now that the election's over, it's up to many states, including Pennsylvania, to decide how they'll implement so-called "health insurance exchanges" required by law. Hoefler says to think of these exchanges as clearinghouses for comparing costs and quality of different types of healthcare plans, similar to a travel website that lets customers see rates from different airlines. "You know, you go on, and you say, 'I want to go from here to there. What are my options?' You could pay this amount and have this schedule, or you could pay a different amount, or, you know, you could save a lot of money if you had a three-hop flight, and so it's that kind of thing."

Under the law, the states would either set up their own exchanges, or opt into an exchange run by the federal government.

Many governors, particularly Republicans, put off the decision until after the general election in the event Romney was elected and further implementation of the Affordable Care Act was stalled.

Hoefler says there's a good chance Governor Corbett will decide on a state-run exchange, but either way, his choice won't necessarily be set in stone. "It may be in Pennsylvania's best interest, even if we have an interest in having some control over what the final outcome is, to allow the federal government to step in with their expertise, set the exchanges up, see how they work, and then Pennsylvania can take that control back down the road and make the changes it would like to make."

Corbett has until December 14th to make a decision.

Hoefler says one of the other big choices the Governor will have to make is whether or not to expand Medicaid, which provides health care to some of the poorest people.

An expansion to grant coverage to those people making up to 138 percent of the federal poverty level would cover about 750,000 new Pennsylvanians and cost about $2 billion through 2019.

Hoefler says the federal government is offering help to states looking to expand their programs. "States can buy into that option and get some federal dollars to help expand coverage under Medicaid, or they can say, 'No, we like the Medicaid we have now.' So that was the one thing that the Supreme Court said, that the federal government cannot force the states to expand its Medicaid coverage without their compliance."

The Corbett administration has said it's written to the federal Health and Human Services department to ask some questions about expansion before making a decision.

Hoefler says no matter what Corbett decides to do, he sees the Affordable Care Act becoming a giant of American legislative policy, similar to Social Security. "People may not like it, but the end of the story is, this train has left the station. I would be really surprised to see any substantial retrenchment of this law."

For now, most parts of the Affordable Care Act are moving along right on schedule.

For more information on health care policy, check out witf's new, multimedia initiative, Transforming Health.

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