Like a sick patient who somehow always rallies, President Obama's health care law survived another scare Tuesday with Mr. Obama's defeat of Republican challenger Mitt Romney on Tuesday.
The future of the Affordable Care Act, better known as Obamacare, appears secure with Mr. Obama's victory over an opponent who vowed to begin repealing the law on his very first day in office. The sweeping health care law, the crown jewel of Mr. Obama's first-term agenda, had previously cheated death in June when it was upheld by the Supreme Court on a 5-4 decision.
With Mr. Obama in office for another four years, nothing stands in the law's way except another three dozen lawsuits, continued Republican opposition in Washington and dozens of state capitals, and the administration's own ability to implement the law by meeting a series of benchmarks and deadlines leading up to full implementation in 2014.
The administration delayed until after the election submitting some of the law's more controversial requirements, such as explaining what constitutes a "minimum insurance-benefits package." With the election over, all eyes will now be on administration regulators to fill in the gaps, said analysts.
"They've been holding back on a huge overload of regulations because of the election," said Grace-Marie Turner, president of the Galen Institute, a health care policy research organization. "They really did turn off the buzz saw for a few months for the election. We've been in this kind of lull before the onslaught really begins."
The first deadline comes Nov. 16, when governors are required to say whether their state will participate in the federal health care "exchanges" where consumers will purchase their insurance after 2014. Most governors put off the decision until after the election, in part because they feared -- or hoped -- Mr. Romney would make the task unnecessary.
"We're about to find out how many garments the emperor has on," said Ed Haislmaier, senior research fellow at the Heritage Foundation. "I'm watching to see what regulations come out. When they come out, and what they say, will tell me whether they're anywhere near meeting the statutory deadlines of Oct. 1, 2013, which is when this whole thing is supposed to go live."
Four states tried to put the brakes on Obamacare in Tuesday's election with ballot measures that limit the law's reach. Alabama, Missouri, Montana and Wyoming voted to approve anti-Obamacare measures, though Florida narrowly rejected an amendment that would have banned mandatory insurance regulations.
Critics said the rejections were largely symbolic, given the Supreme Court's decision to uphold the law. Still, the states do have some control over how the measure is implemented. For example, the Missouri measure, Proposition E, prohibits the state from setting up a health care exchange.
Exit polls Tuesday showed that voters still aren't sold on the law. The survey found that 49 percent of voters wanted to repeal all or some of Obamacare, while 44 percent wanted to keep it as is or expand it, with large partisan differences on who supported the law.
Obamacare was seen as the driver behind the Republican surge in the 2010 election, but analysts say the issue failed to resonate as powerfully with voters in 2012. One reason may be that another year had passed and voter anger over the bill had muted.
Another factor was that Mr. Romney didn't attack the president on the details of Obamacare, such as the individual mandate, perhaps in part because he had signed a health care measure while governor of Massachusetts that also contained a requirement that all state residents purchase health insurance coverage.
"In a presidential election, first of all there are lots of other issues, but Romney really didn't get into why he didn't like the law or what he would do himself," said Ms. Turner.
Given the length and complexity of the law, Mr. Haislmaier predicted the administration would have trouble meeting some of the mandatory deadlines, which could result in the president asking Congress for extensions.
Since Republicans still control the House, any request for an extension could present a ripe opportunity for GOP leaders to secure concessions. Democrats strengthened their hold on the Senate in Tuesday's balloting by gaining one seat and a second in the form of an independent likely to caucus with them.
"They would need Congress to push back deadlines, and I think Congress should extract a price," said Mr. Haislmaier.
© Copyright 2015 The Washington Times, LLC. Click here for reprint permission.