WASHINGTON – A law the Republicans swore they would repeal because it created instability for businesses is now the law of the land. House Speaker John Boehner, R-Ohio, agreed Thursday that Obamacare is now settled law; then he issued a statement vowing to repeal it. So much for the GOP’s arching concerns about creating a solid platform for investments and jobs.

In New York, the comptroller reported that Medicaid, the health care program for the poor that will be expanded under Obamacare, cost $41.4 billion last year – an increase of 26 percent over four years. The Cuomo administration, under the whip of Obamacare, will grow Medicaid eligibility and payment for providers this year as it did last year, according to the Kaiser Family Foundation. Much more in 2014.

Yet at the same time, the governor’s budget people are projecting they will find $1 billion in Medicaid savings, partly because of program “redesign.” This is Albany arithmetic, for sure.

According to Kaiser, New York was among a minority of states that did not order major program retrenchments. New York cut back only payments for home physical and speech therapy.

The president’s re-election and the continued Democratic Senate majority guarantee that the Patient Protection and Affordable Care Act is repeal-proof until 2017 at the earliest. Republicans can peck away at it, such as funds for enforcement in 2014 of the business and individual health insurance mandates. Lack of enforcement, however, could create a nation of scofflaws.

Many basics will remain, according to Michael Mahoney, vice president for GoHealth, a health care consultant. Among them are protections against pre-existing conditions, against losing insurance because of illness and against lifetime limits for benefits.

Mahoney said health insurance exchanges will help families make better choices, like avoiding coverage they don’t need. They are unlikely to reduce overall costs, he said. Gov. Andrew M. Cuomo has provided for an exchange in New York. However, Cuomo does not have it up and running, Kaiser said.

In addition to steady expansion of Medicaid eligibility, the law next year orders more electronic exchanges of patients’ medical information, and simplification of billing. States will have to pay Medicaid providers at least what Medicare providers get. Medicare payroll taxes are going up for singles making $200,000 and for joint filers earning $250,000, and there will be a 3.8 percent tax on stock dividends and other unearned income for high-end taxpayers.

No one really believes the Obama administration or participating states know where the money is coming from to create universal care. House Republicans will surely take aim at Medicaid outlays in the current and future budget talks, with the result leaving generous New York-style programs high and dry.

The law is already taking nicks out of health care. Some Medicare patients are finding their procedures kicked into the indefinite future. Home care therapists funded by Medicare are looking at cuts in payment starting Jan. 1.

Dr. Stephen Evans, a Buffalo physician, sees some problems under the radar, including “lots of new penalties” for hospitals, home care, drug companies and physicians to help pay for the reforms.

“Oversight will become more politically based, so that unannounced examination of practices without any complaint will make everyone vulnerable. This already started,” he said. “The Feds are following New York’s model of putting all providers at constant risk, which will encourage the end of small practices not able to afford in-house legal support.”


Put all post-election analyses through the strainer and at the bottom remains a simple answer: You can’t beat a presidential incumbent unless you have a candidate most people like and trust.