We spoke with Robert Blendon, professor of health policy and political analysis at the School of Public Health and faculty member of HKS, about the Affordable Care Act and its challenges on the president’s radar screen.

Q: What health care policy priorities should be atop the president’s agenda in his second term?

A: The election is now over and there is no longer an immediate legislative threat to repealing the Affordable Care Act. But to the surprise of many in the policy community, the debate over the future size and scope of this major piece of healthcare legislation continues. Within the last few weeks, the majority of state governors have indicated an unwillingness to move ahead with state-managed health insurance exchanges, leaving the federal government to take on this task. Also, many have announced that they will not move ahead with expanding their current Medicaid programs due to perceived concerns about the long-term fiscal impact on their state budgets. In many states almost half the uninsured who were to be covered by the ACA were to receive Medicaid. Thus the near-universal nature of this national insurance legislation remains at risk unless these states change their positions and move forward with the Medicaid expansion.

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