In addition to the Supreme Court challenge to the Patient Protection and Affordable Care Act (PPACA), the upcoming presidential and state elections are likely to have an effect on the implementation of the law. Milliman consultants John Meerschaert and Michael Sturm projected some of the possible outcomes in a recent feature story. As they point out,
The November 6 general election may prove to be a bigger factor than the Supreme Court decision, because the potential result could be a complete repeal of the PPACA.
Assuming the law is not struck down in its entirety by the Supreme Court, the authors predict that the elections are likely to result in one of the following outcomes for the PPACA:
- President Obama is reelected. Repeal legislation will be vetoed, the PPACA will move forward in whatever form is left by the Supreme Court, and exchanges will go forward.
- A Republican president is elected, but the Democrats control at least one house of Congress. No attempt at repealing the 2010 legislation is likely to pass, and the PPACA will remain the law of the land. Major provisions of the law may be delayed, especially exchanges.
- The Republicans capture the presidency and both houses of Congress. The PPACA will be significantly modified, if not repealed. Without federal subsidies, states would have less incentive to create exchanges, although some states might keep moving forward.
One of the most interesting questions is this: if they win, what would Republicans replace the PPACA with, if anything? The National Journal offered some perspective in a recent discussion, and Uwe Reinhardt today offered his take on the Economix New York Times blog.