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President Barack Obama reaches for a pen to sign the health care bill in the East Room of the White House. Obama's re-election has guaranteed the survival of his health care law.
WASHINGTON--The long slog has turned into a sprint. President Barack Obama's health care law survived the Supreme Court and the election; now the uninsured can sign up for coverage in about 11 months.
Even the government's top-ranking Republican, House Speaker John Boehner of Ohio, said Thursday that "Obamacare is the law of the land." But not all hurdles have been cleared.
Republican governors who opposed the law have to decide whether it's better for their states to now help carry it out. The administration could stumble carrying out the complex legislation, or get tripped up if budget talks with Congress lead to scaling back the plan.
"We are out of the political gamesmanship and into the reality," said Sandy Praeger, Kansas' Republican insurance commissioner. Next week, states have to say if they're committed to building the framework for delivering health insurance to millions.
"We are still going to be struggling through the politics, and there are important policy hurdles and logistical challenges," said Andrew Hyman of the nonpartisan Robert Wood Johnson Foundation, helping states carry out the law. "But we are on a very positive trajectory."
Instead of being dismantled by a Republican president and Congress, Obama's law is now on track to take its place alongside Medicare and Medicaid. The action starts right away.
A week from Friday, states must notify Washington if they'll be setting up new health insurance markets, called exchanges, in which millions of households and small businesses will shop for private coverage. The Health and Human Services Department will run the exchanges in states that aren't ready or willing.
Open enrollment for exchange plans is scheduled to start Oct. 1, 2013, and coverage will be effective Jan. 1, 2014.
In all, more than 30 million uninsured people are expected to gain coverage under the law. About half will get private insurance through the exchanges, with most receiving government help to pay premiums.
The rest, mainly low-income adults without children at home, will be covered through an expansion of Medicaid. While the federal government will pay virtually all the additional Medicaid costs, the Supreme Court gave states the leeway to opt out of the expansion. That adds to the uncertainty over how the law will be carried out.