Come November 6, things in Washington could stay largely unchanged or shift radically, depending on the outcome of the upcoming presidential election.
What Could Change?
Current plans and promises aside, there likely wouldn’t be much change in another four years of Obama.
But in the case of a Republican win, everything – from tax credits/cuts/breaks to malpractice insurance to market reforms will likely get turned on its head.
By far, the most dramatic change likely to happen to the U.S. healthcare system, through, in the case of a Republican-run White House, is possible repeal of the Affordable Care Act (ACA).
“The 2012 election will be the most important in the history of our health care system because it will determine whether the Affordable Care Act is implemented or repealed,” Harvard health policy expert David Blumenthal wrote this past December in the New England Journal of Medicine.
As is the intention – more or less – of every GOP candidate in the running, a Republican president would almost certainly seek to repeal the ACA after a 2012 election win.
Alternatives to Outright Repeal
At the very least, a Republican president could significantly weaken the Affordable Care Act using executive power, granting waivers from its regulations and mandates. A Congress and several dozen state governments hostile to the law could further help write it out of the history books in the case of a GOB presidential win.
While Mitt Romney, Newt Gingrich and other GOP candidates have been more diplomatic in their phrasing, Minnesota congresswoman Michele Bachman warned party members in countless speeches, before exiting the Republican Presidential race: “We cannot afford to have a candidate who fails to understand the complexity of Obamacare or the urgency of its repeal…We have only have one chance for repeal, and that’s 2012.”
Even with control of the House and the White House, a total ACA repeal still wouldn’t be a sure-thing, as long as there are at least 41 Democratic senators to mount a filibuster. But if Republicans control the White House, the House of Representatives and the Senate (which could happen in 2013), the GOP could effectively bring down the law by intentionally shipwrecking its implementation and then repealing its less popular provisions.
If Republicans don’t capture the presidency in 2012, they may still be able to limit some funding for the health law’s implementation, but repeal would pretty much be off the table at this point. Because of a few key milestones after 2012, any attempts to repeal the law after a potential 2016 Republican win would be far tougher.
Healthcare in an Affordable Care Act reality
Another reason ACA may actually survive a GOP presidency in 2012 or 2016 – at least in-part –is that public opinion of the act may actually improve once its major benefits kick-in.
2014 is likely the make-or-break year for the act in terms of this, as most of the Affordable Care Act’s benefits take effect that year, including some of the more publically-desirable ones, such as guaranteed coverage regardless of pre-existing conditions, subsidies to help low-income people buy insurance, the expansion of Medicaid, and a ban on annual caps for coverage, as well as the creation of insurance exchanges to lower costs for consumers and small businesses.
A Tale Of Two Healthcare Visions
If re-elected, President Obama, will be extremely motivated to ensure that Americans are able to enjoy such benefits, which will radically reshape the face of the U.S. healthcare system for-better-or-worse.
If a Republican president is elected, we’re still likely to see a major healthcare shakeup, as the planned adjustments needed during implementation of the Affordable Care Act disappear, or as the last remnants of the plan to survive repeal are melded with an alternate reality, where lawmakers seek to blend those remnants with the U.S. healthcare framework that exists today.