Obama's election win also a win for ACA

The Republican primary season begins in earnest with a gradually narrowing field of candidates targeting Obamacare (a term the president would embrace by the end of the year) for some of their harshest attacks on the president and each other.

Former Pennsylvania Sen. Rick Santorum, at a January debate, attacks Mitt Romney as the architect of a template for the federal healthcare law because of the 2006 reform that Romney signed in Massachusetts. He also criticizes former House Speaker Newt Gingrich for proposing ideas during the Clinton administration that would become core provisions of the Affordable Care Act.

Every Republican contender, however, vows that repealing the healthcare law would be a top priority. All also advocate a fundamental shift in the way the government delivers Medicare benefits, suggesting beneficiaries get a fixed benefit to buy coverage from private health insurers—so-called premium support. Democrats attack that as a voucher.

Less than two weeks after the Supreme Court upholds the Affordable Care Act, the Republican-controlled House votes again to repeal the law, signaling the outcome has done nothing to defuse or discourage opposition.

After Romney wins the nomination, he chooses Rep. Paul Ryan (R-Wis.) as his running mate and formally ties his candidacy to Ryan's proposals for Medicare vouchers and Medicaid block grants that were part of the budget proposals he wrote as chairman of the House Budget Committee.

“This is an idea whose time has come,” Ryan says in an interview with Modern Healthcare shortly before he is elevated to the ticket. But while many expected Romney and Ryan would bring that debate to the fore of the campaign, they instead train their fire on $716 billion in cuts to providers and Medicare Advantage plans included in the Affordable Care Act, arguing that Obama's attempt to create new benefits for the uninsured is undermining coverage for seniors.

Obama wins re-election, leaving even the reform law's harshest critics mostly resigned to the likelihood that it will stay on the books. But they still aim to undo unpopular provisions such as the Independent Payment Advisory Board.

Industry groups continue to lobby for Congress to roll back parts of the law that they agreed to back in 2009 and 2010 as the White House and Democrats look for ways to make the numbers work. Device companies want to kill the device tax. Insurance companies want to kill a tax on insurance premiums. Hospitals want to restore cuts to disproportionate-share hospital payments, arguing they aren't getting what they bargained for since it's likely that a smaller slice of the uninsured will be newly covered by Medicaid.

As the year ends, Obama and House Speaker John Boehner near a deal to avoid an economically devastating round of tax increases and across-the-board budget cuts that continue to whittle away at payments to providers.