President Barrack Obama pledges to stay the course with the Patient Protection and Affordable Care Act (ACA). Governor Mitt Romney promises to dismantle it. Neither man may have the authority or political power to do it. And that’s why this election is so important.
Today, on the eve of the national election, healthcare arguably is the most important issue. When Pres. Obama took office in 2009, he had a Democratic House and Senate, and together these two legs of the three-legged stool that oversee our federal government passed the ACA. The backlash from this and other reforms enabled the Republicans to win back the House in 2010, and since then, the federal government has been gridlocked. But the ACA continues to chug along.
The challenge facing the president and Congress in the next term is budget deficits, and healthcare reform is one of the few areas affecting the federal budget where Congress and the president have the ability to make substantive reductions.
President Obama has pledged to keep the ACA on track, but during his second term the ACA reforms and corresponding new costs will be fully realized. The president has also promised to attack the growing federal deficit, but that pledge will be rubbing against the expansion of healthcare reform.
Gov. Romney’s promise to use his authority as president to roll back the ACA is equally shaky. As Gov. Romney learned in Democratically controlled Massachusetts, the powers of the chief executive are limited. The ACA is federal law, and as president he has an obligation to implement it. His pledge to use the authority of the president to “waive” provisions of the ACA for the states is untested and may even be illegal.
In the end, it will fall to Congress to modify the ACA, which it stands to do regardless of whether Gov. Romney or President Obama takes office. The battle over healthcare, therefore, is not just an issue facing the presidential candidates, but also the candidates for Congress — all 435 members of the House of Representatives and 33 members of the Senate.
It doesn’t end there. The Supreme Court decision in July required that states be given the option of implementing the provision of the ACA that expands Medicaid coverage to those who earn less than 133 percent of federal poverty guidelines. Governors in six states have stated they are not in favor of expanding Medicaid; eleven states will be voting for governors in this election.
How states fund Medicaid, regardless of whether there is an expansion or not, falls to the respective state legislatures, of which there are thousands of races across the country.
When it comes to healthcare, your vote counts. Who do you want legislating healthcare?