Most Americans tend to want to vote on a sure thing, especially one that can make a difference in their lives. Healthcare reform is the most surefire aspect of this campaign that voters can influence when they go to the polls Nov. 6.

Healthcare reform is not a campaign promise but a policy that is already law, signed into law in 2010.

It expands Medicaid to millions of working poor and offers tax credits to those earning moderately more to offset the cost of insurance if their employers do not offer it. A loss of job will no longer mean a loss of health coverage. And efforts to improve healthcare quality within the law also aim to reduce costs.

Former Massachusetts Gov. Mitt Romney has pledged to repeal the health reform law, or at least stop it in its tracks, with no replacement plan put forward. President Barack Obama will continue to roll out pieces of the Patient Protection and Affordable Care Act (ACA), with its major coverage expansions and health insurance exchanges to be in place in January 2014.

“Voters can truly count on it,” unlike Romney’s tax reform plan or Obama’s deficit-reduction plan, said economic and domestic policy blogger Ezra Klein recently in the Washington Post.

“If Obama is re-elected, we will see the first iteration of a uniquely American universal healthcare system,” he said. 

While commercial health insurers will continue to deliver the majority of coverage under the ACA, they will not be able to cherry-pick the least sick and least expensive customers as they did in the past. Health insurance exchanges will give consumers access to price and quality information so they can compare coverage before they purchase, like most online services that Americans are accustomed to now.    

Here are 10 of the many ACA benefits that voters will decide to keep or throw out when they select the next president:

1. Tax credits for small businesses to help them provide insurance benefits to their workers, up to 35 percent of an employer’s contribution to the employees’ health insurance.

2. Bridging seniors’ gap in Medicare prescription drug coverage known as the “donut hole.”

3. Helping early retirees afford to continue coverage before they are eligible for Medicare at 65 before insurance exchanges launch.

4. Pre-Existing Condition Insurance Plan (PCIP) provides new coverage options to individuals who have been uninsured for at least six months because of a pre-existing condition as a bridge to 2014, when all discrimination against pre-existing conditions will be prohibited.

5. Young adults may stay on their parent’s plan until they turn 26 years old.

6. New plans must cover certain preventive services such as mammograms and colonoscopies without charging a deductible, co-pay or coinsurance.

7. Insurers are prohibited from imposing lifetime dollar limits on essential benefits, like hospital stays.

8.Insurers may not deny coverage to children under the age of 19 due to a pre-existing condition.

9. At least 85 percent of premiums must be spent on health care services and health care quality improvement for plans sold to large employers. For individual and small employer plans, at least 80 percent of the premium must be spent on benefits and quality improvement. Otherwise insurers must pay rebates to consumers.

10. To test new ways of delivering care to patients, the Center for Medicare & Medicaid Innovation was established. New methods are expected to improve the quality of care and reduce the rate of growth in costs for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Physicians are provided incentives to form accountable care organizations to better coordinate patient care and improve the quality, help prevent disease and illness, and reduce unnecessary hospital admissions. If ACOs deliver high quality care and reduce costs to the healthcare system, they can keep some of the money that they have helped save. The Value-Based Purchasing program in Medicare offers incentives to hospitals to improve the quality of care by publicly reporting measures, beginning with those relating to heart attacks, heart failure, pneumonia, surgical care, health-care associated infections, and patients’ perception of care.