What promises can politicians keep?

WASHINGTON—Healthcare is one of the top issues in the 2012 presidential election, and all the candidates are promising big things. For Republican candidates, their platforms all rest soundly on repealing the Affordable Care Act of 2010 (ACA).

For the incumbent, President Obama, his platform promises to carry through with implementing the majority of the new law in 2014, “to lower costs and expand coverage.”

Joseph Antos, an analyst for the American Enterprise Institute for Public Policy Research says GOP candidates say words that seem to mean repeal, but the president alone can’t repeal anything. “If the Republicans take the White House, they could certainly start the ball rolling [on repeal], but it’s really up to Congress to take that action,” he says.

Antos also predicts a bitter budget battle this year. Even more bitter than last year. This will put pressure on Democrats to show the value of their healthcare programs. The Obama Administration has spent billions through the stimulus package to promote the advance of healthcare IT to lower costs. Accountable care organizations won’t get off the ground, Antos predicts. They demand providers to take on too much risk.

President Obama is going to have a difficult – if not impossible – time making good on his promises with the ACA, he warns.

According to Dean Rosen, a partner at the law firm Mehlman Vogel Castagnetti, Inc., in Washington, D.C., and former chief health adviser to Senate Majority Leader Bill Frist, MD (R-Tenn.), it would be difficult to repeal the health reform law. “It’s a long, detailed and complex law, touching so many areas,” he says.

If the election results in a Republican Congress and a Republican president, Rosen predicts the new president will “certainly make good” on his promise to repeal. “It won’t take one day, but it could be done with more time.”

Rosen says from a Republican perspective, what the candidates are saying is meaningful in this day and age. “You have to follow through on what you campaign on, and history bears that out. It has always been true, but it’s even more so, now.”

Depending on the election outcome scenario and the status of the healthcare reform law after the Supreme Court decision in March, another risky issue for presidential candidates is the replacement of the law after it is repealed. Whoever wins the election will need to provide “direction and promise” on healthcare reform, Rosen says.