resident Obama faces a divided Washington, and any legislation he enacts in the next two years will have to be approved by the Republican-controlled House and overcome filibuster threats from the Senate's GOP minority. But just by winning a second term, Obama "cements his signature law — ObamaCare — in American history," says Diane Stafford in The Kansas City Star. The Patient Protection and Affordable Care Act survived a Supreme Court challenge and Mitt Romney's vow to repeal it "on Day One" of his presidency, and now even House Speaker John Boehner (R-Ohio) admits that "ObamaCare is the law of the land." But it's not quite that simple. Between the reams of unwritten rules and guidelines and antagonistic governors, a lot of ObamaCare is up in the air before it fully kicks in in 2014.
The issue: Improving America's health care system
The patchwork of employer-supported private insurance policies and government programs that make up the U.S. health care system is far from perfect — only 15 percent of U.S. doctors think America's system "works well," according to a new survey from the Commonwealth Fund. And doctors' job satisfaction is the lowest among the 10 industrialized nations polled, even though American doctors make way more money than their peers abroad. At the same time, by every measure, the U.S. spends much more on health care than any other developed nation, and in most cases gets less-than-average health outcomes.
Plans to expand U.S. health care to cover just about everybody have been proposed since the Roosevelts — Teddy campaigned on creating universal health care in his unsuccessful 1912 run and Franklin considered a federal health care system from his Social Security legislation. Instead, action has been piecemeal: Lyndon Johnson enacted Medicare and Medicaid, Bill Clinton added millions of children to Medicaid, and George W. Bush added a prescription drug benefit to Medicare. In his first term, Obama came the closest yet to universal health care, with a law that will add some 30 million Americans to the ranks of the insured though a combination of carrots (subsidies for low-income and many middle-class families) and sticks (the individual mandate). But even when ObamaCare is fully implemented, millions of Americans will still be without health insurance.
How Obama can further improve health care
"The implementation of legislation is as important as its passage," says Martha Kumar in The Baltimore Sun. To "solidify his gains" in health care, Obama must carefully write the regulations that will make the law work. That's no easy task, says Dan Diamond at California Healthline. Yes, some of the law's more popular provisions are sure to implemented no matter what, including barring insurers from balking at pre-existing conditions and keeping children on their parents' health plans until age 26. But other key parts rely on states, and Obama will have to work hard to get these provisions implemented. That includes the expansion of Medicaid to people earning up to 133 percent of the poverty level, which the federal government will fully fund for three years, and the creation of health insurance exchanges that allow uninsured people to buy coverage at lower group-plan rates.
Well, says Ethan Rome at The Huffington Post, you can be sure that Obama and his team will fight and cajole to ensure "a bright future for the Affordable Care Act." But perhaps the biggest health care challenge will be to make sure that any fiscal "grand bargain" doesn't include damaging cuts to Medicare and Medicaid.
How critics can still undermine ObamaCare
"Champions of ObamaCare want Americans to believe that the president's re-election ended the battle over the law," say James Capretta and Yuval Levin in The Wall Street Journal. "It did no such thing," and all this talk of inevitability is designed to pressure Republican governors into "implementing it on the administration's behalf." Many won't. And if they refuse to expand Medicaid or set up insurance exchanges, ObamaCare starts to unravel. With the exchanges, especially, if the states balk, the federal government has to step in with its own version, "and it is far from clear that the administration could operate the exchanges on its own." Obama might have won a second term, but 30 governors are Republicans, and "states that refuse to create their own exchanges would effectively be repealing a large part of the law."
There's one other way Republicans could steal victory away from Obama, says Tina Dupuy at her blog: "Admit ObamaCare was their idea," then "reclaim what is (ahem) rightfully Republican!" The law is only getting more popular, and to be fair, it was originally Richard Nixon's idea, first implemented by Mitt Romney. So, GOP, "let liberals whine about the public option. Let them pine for socialized medicine. Let them lament that private insurance won't bring down costs enough. Let them finger-wag about all the issues we'll have to face going forward." You had a plan, it's now the law, and "people like it. So own it. It's yours anyway."
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