CHICAGO — Now the real work begins.
When voters on Tuesday handed President Barack Obama a second term, they also ensured the survival of his 2010 health care overhaul law, clearing the way for its planned implementation in 2014.
Obama’s re-election stripped away the remaining uncertainty among state governments, hospitals, insurers, doctors and health care companies surrounding the fate of the controversial law, which rival Mitt Romney promised to repeal if elected.
But as one layer of uncertainty was lifted, another came into focus.
“A lot of questions are still out there. This is an enormously complex law,” said John Lapinski, a principal with Buck Consultants.
The federal government has been slow to issue rules related to several of the law’s provisions, and some states have taken a cautious approach with the implementation of infrastructure to support the law.
Now they’re racing to meet deadlines and ensure that systems are in place before Jan. 1, 2014, the day the major provisions of the overhaul go into effect.
The first major deadline facing states is about a week away. On Nov. 16, states are required to submit to the federal government a blueprint of insurance exchanges, the primary marketplace from which consumers will be able to choose individual health insurance plans.
As part of the law, each state is required to have a working online exchange beginning in October, where individuals and small businesses can shop for commercial health insurance plans based on cost and quality. The federal government will set up exchanges in states that choose not to set up their own.
Because a majority of states have been so slow to adopt the exchanges or refuse to participate at all, some in the industry are raising questions about whether the program will be ready in time.
“It’s almost impossible to see how all of these pieces are going to be in place 11 months from now,” said Michael Sachs, chairman and chief executive of Skokie, Ill.-based Sg2 LLC, a health care information and market research company. “We expect there to be a delay in implementation. There’s just too much to do and not enough time.”
Aside from setting up the exchanges, the state also has to devise how to prepare for the expansion of its Medicaid program, which could enroll an additional 500,000 people in 2014.
Several details of the program have yet to be decided. That’s made it difficult for providers to plan.
“In the next few months, there are going to be a lot more regulations coming out of the federal government that will help shape what this thing is going to look like and what it’s going to mean for us,” said Nicole Kazee, director of health policy for the University of Illinois Hospital & Health Sciences System.