With the election now in our rearview mirror and the President’s second term set to begin in January, it’s important to take a look at how this result will shape the healthcare landscape and, in particular, impact the fight against chronic disease.  With near certainty, the President’s landmark Patient Protection and Affordable Care Act will continue with its full implementation and that brings with it many considerations.  For example, one of the more compelling plotlines involves the establishment of state-based health insurance exchanges, market-based systems that would greatly expand coverage across the country and get many on the path to better health.  Many Republican governors had been waiting until post-election to decide what to do, but as Kate Pickert from Time noted this morning, “governors will soon decide whether to set up their own health insurance marketplaces to regulate individual and small business health plans.  States that opt not to set up exchanges will open the door for the federal government to run them instead.”  Many analysts believe that resistance, even in states with the staunchest opposition, will wane in the coming months since the alternative to doing it themselves means ceding implementation to the Federal government, an even less desirable option to many on the right.

Expanding Medicaid will also be hotly debated.  As the main mechanism for expanding coverage to the uninsured, this directive has been met with resistance in many places as well.  Compounding that resistance was the Supreme Court’s “opt out” provision in their decision on the President’s health reform law: states now have the option to opt out of Medicaid expansion if they choose to do so; it is no longer a mandate.  How this option will affect the uninsured is anyone’s guess.  According to Phil Galewitz of Kaiser Health News, “Since the court’s decision, six Republican governors in Texas,Florida, Mississippi, South Carolina, Louisiana and Georgia have said they will not participate, even though the federal government would cover the costs of new enrollees through 2016 and at least 90 percent thereafter.  If those governors follow through, they could significantly undermine the law’s goal of extending coverage to uninsured Americans.”  Still, analysts forecast that based on historical precedent, even those opposed to Medicaid expansion will likely come around.   As John Poelman, Senior Director of Leavitt Partners, a consulting firm advising states on carrying out the law, notes in the KHN article, “Not all states will expand Medicaid in 2014, but within a couple of years, all of them will have. That’s similar to what happened when Medicaid began in 1965. The program did not start in every state initially, but nearly all had it by 1970. Arizona was the last state to add the program in 1982.”

It will be interesting to watch the process unfold, but no matter how the law’s major center-pieces roll out, PFCD encourages everyone to consider the impact of chronic disease and the best ways to curb the enormous costs they contribute to our health care system.