Obama wins, future of ACA, HIT uncertain

Analysis

While many early accounts of last night’s party for President Obama hail the news as a boon for the Affordable Care Act (ACA), once that excitement wears off, Americans will realize that it's just too early to tell whether the reelection will actually be fertilizer or formaldehyde for health reform and for what to date has been viewed as bipartisan support for health IT.

Yes, the law remains just that: legislation that passed, survived a Supreme Court challenge and, as of today, is safe from GOP contender Mitt Romney’s campaign promises to repeal it entirely.

While many early accounts of last night’s party for President Obama hail the news as a boon for the Affordable Care Act (ACA), once that excitement wears off, Americans will realize that it's just too early to tell whether the reelection will actually be fertilizer or formaldehyde for health reform and for what to date has been viewed as bipartisan support for health IT.

Yes, the law remains just that: legislation that passed, survived a Supreme Court challenge and, as of today, is safe from GOP contender Mitt Romney’s campaign promises to repeal it entirely.

But there are still quite a few growing pains ahead for the ACA.

The same Republican party that voted to repeal the law more than 30 times in the two years since it passed in March 2010, for instance, has retained control of the House of Representatives and even though Democrats kept the Senate, the type of repeal vote that NPR dubbed symbolic is likely to continue. 

So perhaps it’s telling that the President made mere mention of what many consider landmark legislation in his victory speech, telling the story of a father saying that the ACA spared his family from losing everything to pay for leukemia treatments for their eight-year old girl. A touching story, indeed, en route to shedding light on where his immediate attention will likely turn.

“You elected us to focus on your jobs, not ours," Obama told the crowd at Chicago’s McCormick Place, rattling off the list of priorities. "And in the coming weeks and months, I am looking forward to reaching out and working with leaders of both parties to meet the challenges we can only solve together. Reducing our deficit. Reforming our tax code. Fixing our immigration system. Freeing ourselves from foreign oil. We’ve got more work to do.”

That work begins, of course, with the looming fiscal cliff. That will require the type of cross-aisle bipartisan wrangling that sounds so good in speeches yet has plagued the president – including in the realm of health reform and ACA provisions such as health information exchanges, Medicaid expansion and potentially even the meaningful use program.

EHR incentives

With regard to the incentives for implementing and demonstrating meaningful use of EHRs, whether the four Congressmen who first sent a letter to HHS Secretary Kathleen Sebelius requesting that she immediately halt reimbursements, and subsequently asking for a longer meeting to discuss the prospect continues apace, exposes cracks in the oft-lauded bipartisan support for health IT, or drops into the ether like so many campaign ploys, that won’t require as much time to tell.

[Political Malpractice: Politics, budgets, and reform pummel state Medicaid efforts]

But state-level resistance to health information exchanges and Medicaid expansion have deeper, further reaching roots.

Indeed the usual suspects of conservative, if not Tea Party, governors – from Florida, Georgia, Louisiana, Mississippi, South Carolina and Texas – maintain that they will not expand the number of citizens Medicaid covers. And one could argue that they are doing so to simply put politics ahead of policy, for their own gain.  

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