Four More Years of Health Reform
While the last news I saw this morning before leaving the house still had Florida as “too close to call,” the outcome in that state has become irrelevant, with Obama securing enough votes in the electoral college (303 at last count) and claim another term as President of the United States. Importantly, Obama also won the popular vote by about 2.5 million votes. While the contest was close until the end, and our nation clearly remains divided, I am thankful that we do not find ourselves confronting the legitimacy question that can arise when the winner of the electoral college loses the popular vote. (Think Bush v. Gore.)
So, what awaits us in Obama’s second term? Well, I think it’s clear what needs to be done: More action needs to be taken to improve the nation’s economy. The Obama administration has made some gains in this area with the stimulus and the auto bailout, but there is more work to be done. For me, the question is: Will the Republicans in Congress work with him at all? For four years they’ve played obstructionist politics, with the goal, one would assume, of creating a one-term president and capturing the White House in 2012. That’s why none of them voted for the Affordable Care Act, why they refused to vote on the President’s jobs bill, and why they pushed our country to the brink of default by playing games with the debt ceiling. All of these things were done not because they were the best for our country, but because they were the worst for the President. And, in spite of that, Obama was able to prevail.
This morning, we now know that the Affordable Care Act, better known as “Obamacare,” will have the opportunity to be fully implemented in 2014. We know that tens of millions of Americans without health insurance will soon have affordable coverage. We know that there will soon be an option for individuals to shop for health insurance in a more transparent and competitive system of health insurance exchanges, with a government-sponsored option among the available choices. And we know that our nation’s elderly and disabled will continue to depend on Medicare, rather than facing the possibility of being given a voucher to go out and shop for coverage on their own.
This election has given us four more years of health reform. In that time, perhaps the public will warm to the program the way they have grown to love Medicare and Social Security. Perhaps we’ll see some real improvements in health and health care. Perhaps this will be the impetus for additional reform efforts in the future. But we’re not out of the woods yet. Republicans still control the House, while Democrats cling to a narrow majority in the Senate. It is possible that, through the budget process, Republicans can interfere with the implementation of the Affordable Care Act. It is even possible that, if they make large gains during the 2014 mid-term elections, they could find themselves in the position to repeal the ACA by overriding President Obama’s veto. And, while I hesitate to bring it up so soon, there’s 2016, when we will once again elect our President. Obamacare will only have been fully implemented for a couple of years, and if the economy hasn’t fully recovered, you can bet that the rhetoric of repeal and replace will be on full display. But, for the moment, we can breathe a little bit easier, knowing that we just bought Obama–and Obamacare–a little more time.
I'm an Assistant Professor of Health Management and Policy at the University of Iowa. I received my PhD in health policy and management from the University of North Carolina at Chapel Hill and completed a fellowship in health services research at Brown University. I've worked previously as the Asst. Director of Health Policy for the Assoc. of Clinicians for the Underserved, and as a policy ...