The Affordable Care Act is here to stay, even if nobody seems to know what that means

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John O'Connor
John O'Connor
As late as Friday, House Speaker John Boehner (R-OH) indicated he still would like to upend Obamacare. But he really needs to find a less frustrating way to spend his working hours.

Sorry, Mr. Speaker, but that fight is over. The Supreme Court upheld the law in June. And last week's presidential election ensured the measure will not be overturned via executive fiat.

So like it or not, the law is not going away. Now if we could only figure out what that means.

Regardless, its flywheel has already begun to spin. States have until Friday to let the Department of Health and Human Services know how they plan to address health insurance exchanges, which are to open shop in a little more than 13 months.

On paper, states essentially have three options: Let the feds do the heavy lifting; run their own exchanges; or take a hybrid approach. But you can bet the phone lines will be burning up between Washington and state capitals this week, as various deals and compromises are worked out.

And it's not like the work ends Friday: States have until the first of January to show their marketplaces are on track to begin enrolling people within a year.

Approximately 15 states and the District of Columbia have created the framework for exchanges through legislation or executive orders, according to published reports. Another three states have committed to running exchanges in partnership with the federal government. So even among the true believers, there is still much work to do.

Then there are the Republican governors from states such as Arizona, Idaho, New Jersey, Virginia and Tennessee. They put their bets on Mitt Romney winning the presidential election  — and his promise to bury the ACA. As they say in some parts of West Virginia, and elsewhere, that dog ain't gonna hunt.

But these state executives aren't the only ones dealing with flop sweat. For its part, the White House needs to make some tough choices that could ultimately make or break the new law. That starts with addressing concerns from many corners about the very real possibility that insurance premiums will spike.

The president also must decide whether some of the law's most expensive provisions — such as federal subsidies to help families with incomes up to 400% of the poverty level pay their insurance premiums — can be scaled back in the name of deficit reduction.

No doubt, the White House could do a better job of explaining the nuts and bolts of its master plan. Many millions of people — including more than a few long-term care operators — are still not sure what the law truly entails.

It's one thing to wing it over a long weekend. It's quite another to take the same approach to re-engineering the nation's healthcare system. More worrisome still is that this experiment is being carried out by the same people who parked us next to a fiscal cliff.

Something tells me this healthcare reform prescription may have a lot of unhealthy side effects.

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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.

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