The survival of the healthcare reforms may have been ensured, but each state will have a say.
The re-election of President Barack Obama has been a major step to keep the federal health insurance reforms in place, but it will still be up to the states to decide how those laws will be carried out.
The officials from predominantly Republican states will still have an important say.
The reforms to the healthcare systems give state lawmakers the control over whether or not millions of people without coverage will be able to obtain their plans through Medicaid as of 2014, as was the original design of the Affordable Care Act. The states will also be the ones that decide whether or not they will be establishing health insurance exchanges or whether the federal government will be responsible for those operations.
Now, approximately 30 states will have Republican leaders that will make decisions about health insurance exchanges.
Those states will also have legislatures under Republican control. At the same time, many analysts feel that the Obama victory will encourage the nearly three dozen states – made up by both Democratic and Republican leadership and legislatures – to move forward when they have been reluctant to do so until now.
Many states were very hesitant to continue onward with the health insurance exchanges and other required elements of the healthcare law reforms because they were afraid that if Romney had won, all of their efforts would be reversed. This would have been a massive loss of time, money, and resources. However, now that they see some security in the Affordable Care Act, they feel that they can make their final decisions about the way that they want to carry out the law.
The ruling by the Supreme Court in June gave the states a significant amount of power over the way that the healthcare law will be carried out, when they gave the option to reject the Medicaid expansion provision. That element of the law had been designed to provide coverage to nearly half of the 30 million people who would be receiving health insurance as a result of the Act.