* Re-election ends threat of wholesale repeal of 'Obamacare'
* Reforms still face challenges in Congress deficit
* Medicare not big voting issue, polls show
By David Morgan and Anna Yukhananov
WASHINGTON, Nov 7 President Barack Obama's
re-election erased the last major threat to his signature
healthcare reform law, but left questions about implementation
as the national focus shifts to tackling the mounting U.S.
The 2010 Patient Protection and Affordable Care Act, 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."
Shares in hospitals and other healthcare companies that will
benefit from the health reform law jumped on Wednesday, but
health insurers fell as the law sets limits on their profits and
sets mandates on coverage.
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 Medicaid program for the
poor, during negotiations to cut the federal deficit later this
But Julie Barnes, director of healthcare policy at the
Bipartisan Policy Center, said Tuesday's victory should embolden
the president to set the healthcare segment of any
deficit-cutting compromise largely on his own terms.
"He has the standing to demand that each party see the
investment all Americans have in reforming our broken healthcare
system," she said.
MEDICARE NOT A VOTING ISSUE
During the campaign, Obama's staunch defense of Medicare,
the healthcare program for the elderly and disabled, likely did
not end up helping his re-election.
Obama and his allies vigorously attacked Romney's plan to
convert the popular program that provides guaranteed benefits to
one that gives beneficiaries a fixed payment to help them
purchase their own health coverage.
Polls show older Americans oppose the idea by margins of
2-to-1. But Romney still received 56 percent of the vote among
citizens 55 years and older, a lead of more than 10 points over
Obama, according to an exit poll from Reuters/Ipsos.
The economy was the dominant issue among older votes, as it
was for the broader population. Only 9 percent of senior
citizens selected healthcare as the top issue influencing their
vote, and 6 percent chose Medicare and Medicaid - about twice
the rate for those under 65.
Drew Altman, chief executive of the Kaiser Family
Foundation, said healthcare can often generate heated debate but
is rarely voters' number-one issue.
"This was not a healthcare election," he said. "In the end,
this was about the economy, it was about the two candidates
NOW ON TO STATES
Post-election, the focus on healthcare reform will turn to
the U.S. states, whose leaders must decide whether to expand
Medicaid and set up their own subsidized health insurance
exchanges for individuals to buy 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 the threat of full repeal is
gone. States have until Nov. 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 Obama emerged the winner, reform advocates called
on his 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
"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
The healthcare law that Republicans deride as "Obamacare"
has already 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