Obamacare

One certain result of the election is that health-care reform will be implemented

Before the election, Republicans up and down the ticket had been vowing to repeal Obamacare. That always was a long shot, and now is completely off the table. The remaining questions are all about how well the Affordable Care Act will be implemented and what progress will look like in the coming years.

To actually repeal Obamacare, the Republicans needed to keep control of the House, and win both the Senate and the White House. They did not. President Barack Obama won re-election, and the Democrats picked up seats in the Senate.

That puts the chances of outright repeal at precisely zero. Instead, the act is expected to be fully in place by 2014.

And, with that, supporters and opponents alike must shift from arguing about the law to figuring out how to make it work. Through time, that may well include making some changes. Nothing as sweeping and complicated as health-care reform ever is perfect, let alone from its inception.

Some of that will be a shift in emphasis. After health-care reform is fully implemented, its administration needs to pivot from an almost exclusive focus on universal coverage which presumably will be largely accomplished to stress cost control.

Refocusing, however, is a far cry from repeal. And that is about all critics can expect.

Obamacare was crafted with an eye to history. Social Security and Medicare were hugely controversial when first proposed and enacted. They now have become part of the fabric of American life, and for all the talk of entitlement reform which is necessary no one wants to kill either.

Backers of the Affordable Care Act hope to repeat that. The thinking behind phasing it in between 2010 and 2014 was to avoid politically challenging shocks, allow time for implementation and, perhaps most important, ensure that with Obamas re-election the public had time to become accustomed to its benefits before its foes could undo it.

That plan may well work. While critics have focused on the individual mandate, cost to employers and ACAs supposed takeover of health care, the fact is that it has a number of provisions that are, or will become, quite popular. As the act is fully implemented, that will only become more true.

Will that ensure the success of the Affordable Care Act? Not in itself. But it should give supporters time to make needed adjustments and target costs.

Elections have consequences. And Obamacare is here to stay.

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