NYAPRS Note: Disability advocates here in New York and across the country have strongly backed two major national initiatives that will go forward with the President’s re-election:
- healthcare reform legislation and policy that is aimed at integrating and improving the effectiveness of healthcare (both within Medicaid and private insurance) in ways that will promote and incentivize wellness and recovery outcomes and person-centered care. Here in New York, we can have hope that our Medicaid Waiver proposal to boost our healthcare ‘infrastructure’ to implement healthcare reform will go forward.
- strong enforcement of the Olmstead decision that expects states to serve people with disabilities in the most integrated and independent community settings. The Administration’s Department of Justice has played active roles in many states, including New York, to negotiate ambitious Olmstead plan implementation.
Proponents for these two priorities can feel hope and direct renewed determination to help people with disabilities improve their health and independence in the years to come!
Obama Win Seen As Victory for Healthcare Reform
President Barack Obama's victory serves as a vindication for the Patient Protection and Affordable Care Act, industry experts said soon after the president won re-election Tuesday.
The election also produced a Congress that will continue the existing split in control between the two parties. Democrats were projected by the Associated Press to maintain their Senate majority and the Republicans to maintain control of the House of Representatives.
While Republican lawmakers on Capitol Hill might continue trying to chip away at the law in pieces, they won't be successful in overturning the statute in its entirety, said Eric Zimmerman, a partner with McDermott Will and Emery in Washington.
“Any provider standing on the sidelines? They can now take their head out of the sand,” Zimmerman said. “It's here to stay and it's time to get on board and take on strategies that can position hospitals for success in this brave new world.”
Tom Miller, a resident fellow at the conservative American Enterprise Institute, said any repeal effort is at least temporarily “blocked” in Congress. But the law may regain political significance for Republicans if there are major implementation problems with its major provisions in the run-up to the 2014 mid-term elections.
Additionally, the “status quo” results also may embolden Republicans to continue their efforts to slow the implementation and block funding for the law, said Julius Hobson, a former lobbyist with the American Medical Association who now serves as a senior policy adviser at Polsinelli and Shugart. However, the ultimate effect of defunding efforts will be mitigated by most of the law's major provisions having already received approval for the necessary funds as part of its enactment.
The election results also are likely to produce a temporary delay in a range of scheduled healthcare spending cuts, including a 27% cut in Medicare physician payments and a 2% cut to all Medicare providers, Hobson and Miller said. However, they split over whether the election ultimately places more pressure on the president or House Republicans to compromise for a “grand bargain” next year that includes a resolution of those healthcare cuts.
Obama “is not going to face re-election but he has to govern in office for at least two years and it would accelerate his lame duck status,” Miller said about economic problems produced by political brinksmanship. “He cannot afford even a modest recession.”
Meanwhile, McDermott Will and Emery's Zimmerman said providers should brace themselves for more reimbursement cuts.
“The fiscal cliff represents a mountain of trouble for Medicare and Medicaid and any interest groups dependent on those programs,” Zimmerman said. “It's going to be a difficult year as the president and Congress deal with the Bush era tax cuts, sequestration and the deficit,” he continued, adding that if lawmakers agree to a grand bargain that resolves each of these issues, providers could see cuts of historic proportions. “Medicare and Medicaid represent 25% of the federal budget. You cannot deal with the deficit in a meaningful way without dealing with those programs.”
Obama Win Clears Healthcare Reform Hurdle, Challenges Remain
WASHINGTON (Reuters) - President Barack Obama's re-election victory eliminates the possibility of a wholesale repeal for his healthcare reform law, but still leaves questions about how much of his signature domestic policy achievement will be implemented as the national political focus shifts to the debt and deficit.
The 2010 Patient Protection and Affordable Care Act, which represents the biggest overhaul of the $2.8 trillion U.S. healthcare system since the 1960s, aims to extend health coverage to more than 30 million uninsured Americans beginning in January 2014.
Republican challenger Mitt Romney had vowed to repeal the law if elected, calling it a costly government expansion despite the fact that the reforms are based on healthcare legislation he signed as governor of Massachusetts.
"There's sort of an immediate acceptance that this law will stay in place in some meaningful way," said Chris Jennings, a top healthcare adviser to former Democratic President Bill Clinton. "It's sort of like a big barrier has been removed."
Obama still faces challenges in Congress. Republicans who retained control of the House of Representatives are expected to press for healthcare reform concessions, including delaying and scaling back a planned expansion of the Medicaid program for the poor, during intense negotiations to cut the federal deficit that will begin later this month.
But Julie Barnes, director of healthcare policy at the Bipartisan Policy Center, said Tuesday's victory should give the president added leverage to set the healthcare segment of any deficit-cutting compromise on terms largely his own.
"President Obama has the opportunity to make bold leadership moves toward a bipartisan compromise on healthcare and the economy," she said. "He has the standing to demand that each party see the investment all Americans have in reforming our broken healthcare system."
Did Medicare Help Obama?
Another healthcare issue, Medicare, may have helped Obama on his way to reelection.
The victory included wins in swing states where analysts predicted senior citizens motivated by the campaign's Medicare debate could impact a close contest. The list includes Ohio, Pennsylvania, Iowa, New Hampshire and Nevada.
Obama and his allies vigorously attacked Romney's Medicare reform plan, which would convert the popular healthcare program for the elderly and disabled from providing guaranteed benefits to giving beneficiaries a fixed payment to help them purchase their own health coverage.
Polls have long shown older Americans opposing the idea by margins of 2-to-1, though it was unclear to what extent that opposition translated into votes.
Major provisions of the Affordable Care Act call for cooperation from individual U.S. states, including the Medicaid expansion and the introduction of subsidized health insurance exchanges for individuals to buy their own coverage.
Governors and legislatures in as many as a half-dozen Republican-majority states oppose those plans and can refuse to act on them.
Other states may be ill-prepared for implementation but could begin to take action now that repeal is no longer a threat. States have until November 16 to say whether they intend to set up their own exchanges. Most will need to partner with the federal government to have one ready by 2014.
Soon after U.S. television networks projected Obama the victor, reform advocates called on the Obama administration to encourage state support for Medicaid by assuring governors and legislatures that $930 billion in federal funds for financing the expansion will be pumped into struggling state budgets.
"This guarantee is essential for governors as they decide whether their programs should cover more low-income adults. It is therefore crucial that upcoming federal budget decisions give governors clear assurances that this funding is stable and won't be reduced," said Ron Pollack of Families USA, a Medicaid advocacy group.
The healthcare law that Republicans deride as "Obamacare" already has survived repeated attacks and emerged mostly intact.
The Supreme Court upheld the reforms in a landmark June ruling, but empowered states to opt out of the planned Medicaid expansion without losing federal funding for current programs.
The reform law is still the subject of about two-dozen lawsuits seeking to overturn a requirement that church-affiliated institutions cover birth control for employees.
(Editing by Michele Gershberg, Marilyn Thompson and Leslie Gevirtz)