Don't pop the champagne for ACA anytime soon

While many early accounts of Tuesday's victory party for President Obama hail the news as a boon for the Affordable Care Act (ACA), once that excitement wears off, Americans will realize that it's just too early to tell whether the re-election will actually be fertilizer or formaldehyde for health reform.

Yes, the law remains just that: legislation that passed, survived a Supreme Court challenge and, as of today, is safe from GOP contender Mitt Romney’s campaign promises to repeal it entirely.

But there are still quite a few growing pains ahead for the ACA.

The same Republican party that voted to repeal the law more than 30 times in the two years since it passed in March 2010, for instance, has retained control of the House of Representatives and even though Democrats kept the Senate, the type of repeal vote that NPR dubbed symbolic is likely to continue.

So perhaps it’s telling that the president made mere mention of what many consider landmark legislation in his victory speech, telling the story of a father saying that the ACA spared his family from losing everything to pay for leukemia treatments for their eight-year old girl. A touching story, indeed, en route to shedding light on where his immediate attention will likely turn.

“You elected us to focus on your jobs, not ours," Obama told the crowd at Chicago’s McCormick Place, rattling off the list of priorities. "And in the coming weeks and months, I am looking forward to reaching out and working with leaders of both parties to meet the challenges we can only solve together. Reducing our deficit. Reforming our tax code. Fixing our immigration system. Freeing ourselves from foreign oil. We’ve got more work to do.”

That work begins, of course, with the looming fiscal cliff. That will require the type of cross-aisle bipartisan wrangling that sounds so good in speeches yet has plagued the president – including in the realm of health reform and ACA provisions such as health information exchanges, Medicaid expansion and potentially even the meaningful use program.

With regard to the incentives for implementing and demonstrating meaningful use of EHRs, whether the four congressmen who first sent a letter to HHS Secretary Kathleen Sebelius requesting that she immediately halt reimbursements, and subsequently asking for a longer meeting to discuss the prospect continues apace, exposes cracks in the oft-lauded bipartisan support for health IT, or drops into the ether like so many campaign ploys, that won’t require as much time to tell.

But state-level resistance to health information exchanges and Medicaid expansion have deeper, further reaching roots.

Indeed the usual suspects of conservative, if not Tea Party, governors – from Florida, Georgia, Louisiana, Mississippi, South Carolina and Texas – maintain that they will not expand the number of citizens Medicaid covers. And one could argue that they are doing so to simply put politics ahead of policy, for their own gain.

That perception can just as easily be applied to health insurance exchanges (HIXs). Although blueprints for standing up an HIX are due on Nov. 16, a Kaiser Family Foundation study determined that as of September’s end a mere 19 states were actively working to either build their own exchange or partner with the government to create one.

Here’s why all this matters: Digitizing the health system and enabling exchange of patient and population information, pulling more Americans into the insurance pool, making insurance more transparent – as well as other ACA provisions I didn't mention, such as shared savings via the accountable care model – are all foundational pieces to reforming the healthcare payment system and ultimately achieving the triple aim of improving patient care at a lower cost that bolsters population health.

And a significant chunk of that work must be accomplished in the next four years – against what is still, despite President Obama winning a second term, tremendous opposition at the federal and state level – to ensure that the next president cannot uproot the ACA via “repeal and replace.”

So, yes, we know the law has been preserved. But we’d best let that champagne cork alone until we see how ACA is greeted by all the requisite players during Obama’s second term, amid economic, jobs, energy and military priorities.

Because if even approximately half of America’s states manage to stay on track with ACA provisions, and the others continue their resistance, there will be a profound healthcare digital divide scarring the ACA’s other successes.