Given the stamp of constitutional approval by the Supreme Court last spring and the re-election of the president Tuesday night, it is clear that some form of "Obamacare" is here to stay -- at least for four more years.
So what should we actually expect to happen because of the election results?
There will be a lot of political posturing on both sides, but I would keep my eagle eye on two key provisions in the Affordable Care Act (ACA) -- the more elegant legislative label for Obamacare.
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First, the proposed expansion of Medicaid -- the joint federal-state insurance programs for the poor. The ACA-driven expansion could theoretically provide Medicaid insurance for as many as 30 million poor Americans currently uninsured. I say theoretically because Republicans in the House -- and Republican governors and legislatures in the states -- could certainly try to derail this expansion.
In fact, last spring's Supreme Court decision gave states the power to reject the expansion of Medicaid in their states -- and six Republican governors (Texas, Florida, Mississippi, South Caroline, Louisiana and Georgia) have said they will not participate in Medicaid expansion.
However, my guess is that they -- and every state -- will be under tremendous pressure not to reject the federal money that comes with Medicaid expansion. After all, if they don't take that money, they will still have to come up with plans to take care of the uninsured in their states and provide their own state money to do so.
The other major part of the ACA to follow is the implementation of the state insurance exchanges mandated by the law. These exchanges are intended to provide an easier way (usually an internet site) for any individual or family to more easily choose an insurance program that is right -- in terms of cost and coverage -- for them. This could be especially useful to those who are not covered through their employer and must buy insurance on their own.
This idea has been at the heart of the Federal Employees Health Benefits Program for the nation's 8-9 million federal employees, active and retired, and their families. The exchanges allow federal employees to compare plans "apple to apple" because they all use the same format and they have been vetted by the federal government for accuracy and transparency. The plan is also rightly described as the "congressional plan" because it's what members of Congress use to choose their health insurance.
These state exchanges are scheduled to begin operations in 2014 but the ACA requires that states give federal regulators a plan by Nov.16 this year. That's literally just around the corner. The ACA says if states don't develop their own exchanges, the federal government will step in and run it for them. I suspect this deadline will be moved a bit but I believe the threat of the federal government taking over will stimulate most if not all states (eventually) to develop their own exchanges.
If President Obama had lost, I think both of these major programs would have been dealt a potentially fatal blow. But they have been given a new lease on life. As always, time will tell -- but I now believe that time will bring a positive result for many Americans struggling to find affordable insurance.
This work is the opinion of the columnist and in no way reflects the opinion of ABC News.
Timothy Johnson, MD, MPH, trained as an emergency room physician but switched careers in 1984 when he joined ABC News as its first full time Medical Editor. Although he retired from that role in 2010, he continues as Senior Medical Contributor. Johnson is the author of a new book on healthcare reform, The Truth About Getting Sick in America: The Real Problems with Health Care and What We can Do.