Presidential Race Could Affect Future of Affordable Care Act

The outcome of Tuesday's presidential election likely will determine the future of the Affordable Care Act, Kaiser Health News reports.

If President Obama is re-elected, his administration immediately will face the challenge of implementing the new health insurance exchanges, scheduled to be operational by 2014.

If Republican presidential nominee Mitt Romney wins, he is expected to attempt to repeal the law. Romney also is expected to seek to replace the ACA with provisions that would create high-risk health coverage pools and insurance plans that would be available across state lines.

Both nominees' plans rely heavily on which party has control of the Senate following the election.

A Republican-controlled Senate is necessary for Romney to attempt a full repeal of the law. Meanwhile, if the GOP takes control of the Senate and Obama wins, he would be "an island" surrounded by "a coalition arrayed against ObamaCare," according to Michael Franc, vice president for government studies at the Heritage Foundation.

There might be changes to the ACA even if Obama wins and Democrats maintain control of the Senate, KHN reports. According to KHN, Obama might reduce the federal subsidies for the exchanges or get rid of a medical device tax in order to reduce the deficit. His administration also might agree to reduce the law's Medicaid expansion as part of a budget deal (Hancock, Kaiser Health News, 11/5).

State-Level Exchange Decisions

Meanwhile, if Obama wins, officials in Republican-led states could face renewed pressure to decide by the Nov. 16 deadline whether they will set up their own health insurance exchanges or defer to the federal government to run one for them, CQ HealthBeat reports.

While some Republican governors have said they will not implement their own exchanges, many have yet to announce an official decision.

For example, Arizona Gov. Jan Brewer (R) chose an essential health benefits plan for federal review, but said the state will wait until after the election to make a final decision on the exchange. Similar delays in Ohio could lead to a federally run exchange for the state because officials are not prepared to launch a state-run marketplace, according to a report by the nonpartisan Health Policy Institute of Ohio (Norman, CQ HealthBeat, 11/5).

Nevada Moves Ahead on Exchange

Despite being one of the states that challenged the reform law at the Supreme Court, Nevada has "quietly" been implementing the Silver State health insurance exchange since 2011, Capital Public Radio's "KXJZ News" reports.

Gov. Brian Sandoval (R) has been moving forward with the exchange to ensure that the state maintains control over its marketplace. The state is one of few that have received level two federal funds for an exchange.

CJ Bawden, communications officer for the exchange, said it aims to reduce the number of uninsured state residents from more than 20% to 8%.

The exchange currently has a website and an eight-person staff. In addition, state officials are developing a call center and Web portal (Bartolone, "KXJZ," Capital Public Radio, 11/4).

State Ballot Measures Address Health Reform

Residents of several key swing states -- including Alabama, Florida, Montana and Wyoming -- will vote on ballot initiatives on whether the state should block the ACA's individual mandate requirement, The Hill's "Healthwatch" reports. However, the measures conflict with federal law and would be invalid if passed.

In Florida, the proposed amendment also states that "the private market for health care coverage of any lawful health care service may not be abolished" (Baker/Viebeck, "Healthwatch," The Hill, 11/5).

The questions were placed on the state ballots before the Supreme Court's ruling in June that upheld the law. Sixteen states already had passed similar measures attempting to block the law prior to the court's decision (Radnofsky, Wall Street Journal, 11/5).

In perhaps the most significant health care-related state ballot initiative, residents in Missouri will vote on a measure that would prohibit the governor from implementing an insurance exchange without approval from the state Legislature or voters ("Healthwatch," The Hill, 11/5).