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The State Of Implementation: Health Reform And The 2012 Elections


November 5th, 2012

The Affordable Care Act (ACA) is not on the ballot this election, but its fate is very much up for grabs. The law will likely survive if President Obama is re-elected and Democrats maintain control of the Senate, but is vulnerable otherwise. Republican leaders have threatened to use the same parliamentary tactics to repeal the law that Democrats used to pass it, including a budget-reconciliation process requiring only 51 votes in the Senate instead of the filibuster-proof 60. At least five alternative paths have been identified that Republicans could pursue to halt the law’s implementation through regulatory and budgetary means should full repeal fail.

It would be a mistake, however, to look only at the top-of-the-ticket races when considering what is at stake on Tuesday. Whether reformers or opponents have the upper hand in 2013 will also be shaped by what happens in state-level elections. The role states play in the ACA’s success has important implications not only for how the reform is implemented, but also for how it is has been opposed and how we should understand what is at stake this election cycle.

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