For health care, little has changed. Nothing is settled.

For health care, little has changed. Nothing is settled.:

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While the law is on solid constitutional footing, its future remains uncertain. If Obama is reelected, it is sure to survive through 2014. That means it will begin insuring tens of millions of Americans, and at that point, its repeal will be nearly impossible. If Mitt Romney wins, he promises he will begin the process of repealing it on “day one” of his presidency, and while that schedule might be ambitious, he can, alongside a Republican Congress, get pretty far, pretty quickly, using the filibuster-proof budget reconciliation process.

The reality is that both of these questions will be decided by the presidential election. The winner will clearly decide the fate of the Affordable Care Act, if only by deciding whether it survives to 2014. And he will likely get the opportunity to appoint one or more justices, which could decide whether the Supreme Court continues its rightward shift or swings back towards the left. So while little changed yesterday, it was a reminder of how much could change in November.