After Tuesday’s election results this is one question that comes to mind.

What other changes can we expect with the Republican Party controlling the

Majority in both Houses.

It seems that the Republicans or those newly elected or still in in the Senate and the

House has been given a mandate to work together as well as with the President and “get things done.”

If they are successful the 2016 election will give the Republicans a chance at the Presidency. If they don’t change anything the Party will be doomed to failure for decades. Remember, they only have 2 years to prove themselves. Not a very long time to correct all the wrongs felt to affect us all.

With these thoughts in mind do you think that the Republican elected officials will repeal the ACA? I think not.

First, the ACA is law and more important the President who uses this as his legacy controls the pen, therefore the veto.

So, what should the GOP do? They can’t persist as obstructionists through the next 2 years. They have to strategize carefully and come up with real solutions that will benefit the hard working American voters.

There are 3 important topics that must be researched with solutions and action items created. The GOP lacks the required 60 seats in the Senate to beat a Democratic filibuster, which prevents McConnell and the Republicans from forcing a repeal vote of the Affordable Care Act. Their strategy will have to involve individual measures through budget reconciliation. The budget-reconciliation process allows for passage in the Senate of certain targets for change such as employer and individual insurance mandates and excise taxes on medical devices and health plans with only 51 votes instead of the 60 votes required to break filibusters.

What can we expect to see and what changes can the healthcare industry expect?

Medicaid expansion: I believe that some precarious states will either backtrack on the existing expansions of Medicaid or fail to move forward with an expansion as a result of the key won gubernatorial races. Note that in Arkansas, the newly elected Governor Asa Hutchinson has already said that he intends to curtail the state’s private option Medicaid expansion and in Wisconsin, reelected Governor Scott Walker has already refused to accept federal funds for expansion. In the other traditionally Democratic states of Illinois, Maryland and Massachusetts where all three of the states have expanded their Medicaid programs there seems to be a chance that these programs could be changed or eliminated in favor of a waiver option. Also, Maine, Georgia and Arizona all went with candidates who have not supported expansion in the past.

What about the Individual Mandate, and this is one of the big issues in that all Americans are required under the ACA to either obtain health coverage or accept a tax penalty. This is one part of the ACA that Republicans broadly oppose and went all the way to the Supreme Court and was narrowly upheld in 2012. The new Majority leader has said that dismantling this section of the ACA is a priority for him but would drive up prices for everybody else. However the President will most certainly have to veto a repeal of this measure at some stage. It will put a generally unpopular part of the law in the media limelight on the downhill side to the 2016 presidential election. I doubt that the ACA will lose the individual mandate anytime before 2016, but that doesn’t mean that it is still safe in the future.

However, the employer mandate part of the ACA could realistically get eliminated under a Republican held Senate. This part of the ACA requires companies with 50 or more employees to offer coverage to any employee who works at least 30 hours per week and this was delayed in February by the President, giving employers and employees until 2016 to comply. According to nonpartisan analysts only 500,000 Americans would lose out on coverage they would otherwise have gained in the absence of the mandate.

And another part of the law that will be addressed is the medical device tax. President Obama was unclear but not totally negative about the medical device tax, however he was very clear about where he stands on the requirement that most people acquire coverage or face tax penalties as line that he can’t cross.

During a White House news conference last Wednesday the President stated that he was open to Republican ideas for improving the law.

My wife stated the main issue going forward, that the big problem that the GOP is going to face is to get their act together and stay united on a healthcare agenda and come up with viable and financially sustainable set of solutions. Just look at the last two years of Republican rule in the House where reaching a consensus in the fractious GOP caucus has been described as dicey at best, at times. This could be the case in the Senate even more due to having several members harboring presidential ambitions, which leads to the need to create headlines rather than adhering to the caucus leadership. Both the Senate and House leadership will have their hands full organizing their troops.

Considering that many of the changes in the ACA will cost money it will be imperative that the Republican come up with changes, solutions and a way to pay for it all. Think about the medical device tax. Eliminating the 2.3% tax would cost $29 billion over a decade and raising the bar for full-time work to 40 hours instead of the 30 hours for the employer mandate will cost $83 billion over a decade.

Therefore, the mandate given to the GOP comes with serious considerations and fallback if the Republicans can’t do the job that the American voters have laid on their shoulders. If they don’t perform I predict that they will lose the 2016 presidential race and will lose their majority in both the House as well as in the Senate.