President Obama’s re-election has finally cleared the air on health care reforms. From yesterday’s election results, it can be safely surmised that the enactment of the Affordable Car Act will proceed with tight defined timelines already in place. The focus of the reforms is once again come to rest on the states, whose legislators may be pressed for time to draw up strategies for executing the reform’s recommendations, such as setting up subsidized insurance exchanges or expanding Medicaid managed care among other rulings.

Many U.S. states with a Republican majority have staunchly opposed the healthcare reform and the health insurance exchanges’ implementation, since the exchanges were first proposed under the aegis of PPACA enacted in 2010. The reform efforts also took a severe beating on account of Governor Romney’s pledge to repeal the ACA if elected, which resulted in visible slowing down of implementation efforts over the past few months.

Even though over 16 U.S. states have made considerable progress in setting up health insurance exchanges, the HIX landscape continues to appear murky for almost all the Republican and few of the Democratic run states. With the Republicans lined up to take control of at least 30 U.S. states in the next year, the road to nationwide health exchange implementation will be far from easy, but the President’s victory is likely to nudge states to take concrete steps on health insurance exchange enactment.

November 16 is the stipulated deadline for states to announce whether they prefer to set-up a state-run exchange, partner with federal government to run a state-federal managed exchange, or rely completely on the federal government for running an exchange.

The U.S. healthcare industry may also witness some definite movement in the Medicaid expansion field. In July, the Supreme Court upheld that the states have the autonomy to decide if or not they want to participate in the ACA-proposed Medicaid expansion program. Soon after, several U.S. states had clearly indicated that they will not participate in the Medicaid expansion program. If the federal government allows states to do a partial Medicaid expansion instead of full expansion and still avail increased federal funding, it can be expected that more states will warm up to the idea of expanding Medicaid coverage.

The healthcare industry can now expect a barrage of new federal guidelines and rules to be rolled out, aimed to assist states and other healthcare proponents in efficiently implementing the ACA mandates. With the threat of full reform repeal no longer effective, the U.S. healthcare is likely to become a hotbed of reform-implementation activity.

With the 2014 nationwide health exchange implementation deadline looming large, states that have been unwavering in their refusal to set up insurance exchanges may need to dive in with both feet and devise a clearly defined strategy for setting up a state-based health insurance exchange. For the health insurers and other industry contributors, only the actual implementation of these reforms will reveal whether the ACA does succeed in holding true to its promise of reducing healthcare costs and boosting business opportunities for various healthcare proponents.

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