But, after the Supreme Court upheld the vast majority of the law, there were plenty of reasons to assume that the ACA — or the vast majority of it — would still go into effect even under a Romney presidency:

• Even if one discounted the presidential polling, it has looked unlikely for months that Republicans would gain control of the Senate, and it was never realistic for them to establish a 60 vote majority in that chamber.
• Of the major components of Obamacare, the individual mandate is the only one that polls badly with the American people. And the mandate really isn’t a mandate, since taxpayers can just pay a higher tax if they choose to remain uninsured.
• Some of the other components of Obamacare are highly popular, like parents being able to keep children on their plans till age 26, and would be hard to overturn even if there had been a Republican landslide.
• Obamacare is at heart a Republican plan, even if many have now rebuke it. Mitt Romney instituted a very similar plan in Massachusetts. Given his policy shifting over the decades, did anyone think Romney was really serious about totally throwing Obamacare out and starting all over with some new undefined plan?

By delaying their preparations, states like Georgia put themselves in a bind. The ACA is going into effect, and states need to play catch up if they want to make the law work as well as possible for their citizens.

Yesterday, Governor Deal, citing too many restrictions in how the states can run their own insurance exchanges, ceded power to the federal government to establish and operate the online insurance exchange from which uninsured Georgians will choose their coverage (or not).

So because the state can’t have enough control, we’ve opted not to have any control.

From the AJC’s Georgia cedes control of health insurance exchange to feds:

The exchanges are a pillar of the landmark law that aims to provide millions of uninsured Americans with health coverage. They are online marketplaces where consumers and small businesses will be able to compare the quality and prices of health plans. An estimated 900,000 Georgians are expected to shop on the exchange website — where people will also be able to find out if they are eligible for Medicaid, the government health program for the poor, or federal subsidies designed to make coverage affordable.

Industry observers say a state-created exchange would have been able to respond more quickly to market forces unique to Georgia.

The state also could have had some flexibility in how an exchange operated, such as who would govern it and how it contracts with health plans, said Tim Sweeney, a health-care policy expert at the nonprofit Georgia Budget and Policy Institute.

While Georgia choosing not to create its own exchange may be a missed opportunity, consumers will still have access to the same options under a federal marketplace, Sweeney added.

“Itâ€s important for people to know that there will still be an exchange here,” he said. “Other provisions of the law will be implemented … this is not opting out of the law.”

Governor Deal is also likely to reject the expansion of Medicaid in the state. That’s a key part of the law, too, but the Supreme Court allowed states to opt out of that. At first, the Medicaid expansion would be 100 percent federally funded, and then funded later at 90 percent (if I have my numbers right). So the state government would have to pay relatively little for the dramatic expansion of insurance to low income Georgians. But if we reject that expansion out of principle, keep in mind that Georgians’ federal taxes will at the same time be supporting Medicaid expansion in other states.

And we already guarantee emergency treatment — very expensive treatment — for low income citizens. The Medicaid expansion would give those same people access to preventive care and other basic services that could pre-empt more costly emergency room visits and, more importantly, improve quality of life.

From the Georgia Budget and Policy Institute’s recent post Expanding Medicaid to cover more Georgians is a great deal for Georgia:

Financially, the expansion is a great deal for Georgia because the federal government will pick up the vast majority of the costs – and the state will spend less on services for Georgians without health insurance, because there will be dramatically fewer people without coverage.

The expansion will also give a boost to Georgiaâ€s economy because the federal money coming in will pay salaries of nurses, doctors and other health care workers all over the state.

Finally, and perhaps most importantly, the expansion will save lives and improve the health and well-being of the Georgians who will get needed health care. Georgians who become newly covered through the Medicaid expansion will be healthier and more financially secure as a result, recently published (and still ongoing) studies show.

I actually feel pretty confident that Georgia will eventually get on board with the Medicaid expansion. If the federally established health care exchange works decently well, we might not opt for a state-run one. But that would be too bad.

Republican leaders who have opposed and continue to oppose Obamacare have two options, as I noted in the comments of a lively conversation at Peach Pundit.

They can keep trying to resist it even though it’s the law of the land. That course will virtually guarantee that the law won’t help citizens as much as it could.

Or they can get in the game, implement the existing law as well as possible, and work from within to change it.

I think there are some extremely problematic elements, but parts of the law have been broadly popular right through the debates, like allowing children to stay on their parents’ plans until age 26 and giving chances for people with pre-existing conditions to buy insurance. The individual “mandate” is broadly unpopular, but it’s not really a mandate — anyone who wants to can opt out of buying insurance and pay a penalty at tax time. As I discussed in a recent post, many will figure out how to avoid paying the penalty entirely.

Anyway, I could go on and on about all that, but this post is just to include some interesting links to pieces I’ve read this morning.

First a moving column from Dr. Mark Murphy in today’s Savannah Morning News:

To compartmentalize health care into a political football batted back and forth between the Democrats and Republicans loses sight of its most fundamental element. Health care is not about politics. It transcends that on so many levels.

It is about little Bobby having surgery for a lazy eye, or waiting all night in the hospital lobby after a teenage boyâ€s car accident to hear the trauma surgeon say, “He made it.” The ragged cry of a newborn, an old womanâ€s first step after a hip replacement, and each and every tear shed over lives lost and gained are all part of the equation.

Health care is about all of us.

So when you hear the seemingly political debates and want to plug up your ears over the buffoonery of the election season, think about this: Think about the people you love. Think about the dedicated doctors, nurses and other health care professionals who sacrifice their precious time and limited energies to take care of others they barely even know.

The SMN editorial encouraging sober, rational discussion about whether to opt out of the Medicaid expansion, which would insure approximately 700,000 low income Georgians:

If Mr. Deal and state leaders decide that Georgia wonâ€t take part in Medicaid expansion, some of these Georgians could qualify for a subsidy that will be available through Obamacare and then buy insurance through a special exchange that will be set up. Then they would have coverage — and avoid a federal tax theyâ€d have to otherwise pay.

Hospital officials in Georgia say they have to eat $1.5 billion in expenses each year to treat the poor and uninsured. Thatâ€s huge. To keep their doors open, they must shift costs to paying patients.

All this cost-shifting makes it tougher to follow the money. Just where is it going? Is it fair compensation? Or is there a better way? Thatâ€s what Mr. Deal and other state leaders must find out.

From the AJC regarding insurance from those with pre-existing conditions, which concludes with an anecdote about former Savannah Morning News writer Amy Swann:

Amy Swann sees it differently. The 48-year-old from Augusta believes she would be dead without the health care law.

Swann suffers from a genetic heart condition that killed her father at 46. A few years ago, Swann quit her job to care full-time for her ailing mother, who suffered from dementia. Her COBRA insurance eventually ran out. Her motherâ€s teacher pension checks, which had kept them afloat, stopped coming when she died last year.

Without insurance, Swann couldnâ€t get the treatments she desperately needed. Her heart began racing. She became bloated — gaining 25 pounds of fluid.

“I donâ€t think people understand that your life can change forever in a second,” she said. “A broken leg will put you into bankruptcy.”

Last August, Swann joined the Pre-existing Condition Insurance Plan after having no insurance for the requisite six months. Surgeons implanted a defibrillator in her chest late last year, and Swann said sheâ€ll likely need a heart transplant at some point.

“I have to hang on to this insurance no matter what happens,” she said. “If President Obama had not pushed these policies through, I would be a dead girl walking.”

And from another AP piece, Mass. health law may bode well for federal law: A

An additional 400,000 individuals have gained insurance since 2006, meaning about 98 percent of residents have coverage.

A recent study by the Blue Cross Blue Shield of Massachusetts Foundation found that between 2006 and 2010, the use of emergency rooms for non-emergency reasons fell nearly 4 percent. That was a key goal of the law, since using emergency rooms for routine care is far more expensive than visiting a doctor.

State health officials also point to what they say are increases in mammograms, colon cancer screenings and prenatal care visits and a 150,000-person reduction in the number of smokers after the state expanded coverage for smoking cessation programs.

“Since Gov. Romney signed health care reform here in Massachusetts, more private companies are offering health care to their employees, fewer people are getting primary care in an expensive emergency room setting, and hundreds of thousands of our friends and neighbors have access to care,” said Gov. Deval Patrick, a Democrat and co-chairman of Obama’s re-election committee.

Another reason the law remains popular may be that so many Massachusetts residents receive insurance through work and have been largely untouched by its penalties. The Blue Cross Blue Shield study found 68 percent of non-elderly adults received coverage through their employers in 2010, up from about 64 percent in 2006.

So employer insurance coverage actually increased in Massachusetts since the law was changed in 2006?