If you were expecting certainty over the future of the Affordable Care Act now that the Supreme Court has upheld the measure, think again. Experts speaking this week during a webinar hosted by the George Washington University School of Public Health and Health Services said health reform is moving forward, but much work remains.

U.S. Health and Human Services Secretary Kathleen Sebelius reminded the audience that even though the nation’s highest court has weighed in, “it’s clear that some want to keep the political battle going.” Case in point: Just earlier in the day, the House of Representatives had voted to repeal all or parts of the law for the 31st time since its enactment.

The expansion of the Medicaid program, a provision of the Affordable Care Act that would ensure health coverage for millions of low-income, uninsured families, is proving particularly prickly. Some states, citing fiscal and other concerns, have already pledged to deny expansion. But with its unprecedented federal support, improved access to affordable care and steep cost reductions, Sebelius said, “We think this is a deal that states — in the end — won’t want to turn down.”

“We’ve been through this before with the Children’s Health Insurance Program,” she recalled. “When Congress expanded coverage for kids in 1997 and offered to pay 70 percent of costs, states were initially skeptical.” But within two-and-a-half years, all 50 states had committed to participate.

And what about the law’s implications for public health?

APHA Executive Director Georges Benjamin distilled the answer to one fundamental question: “Does coverage matter? Absolutely. We know 44,000 people die prematurely simply because they have no health insurance. … From a public health perspective, this [law] will make a major difference.”

Benjamin also lifted up the importance of the law’s Prevention and Public Health Fund, a lynchpin in the effort to move our nation from a system that focuses on treating the sick to a system that focuses on keeping people healthy.

Shelia Burke, a health policy advisor and former chief of staff to former Senate Majority Leader Bob Dole, warned that there are a number of political hurdles facing the Affordable Care Act. For some of its opponents, she said, “it’s important to keep before the public the issues that underlie their opposition to the legislation leading in to the fall elections.”

And it is “a window into a fairly fundamental difference … that is really the question of the role of government — both the state and the federal government — with respect to the provision of health services, the financing and delivery of services.”

A number of initiatives will be coming up at the end of this year in a two- to three-month span that will present opportunities to pursue reductions to the programs in the Affordable Care Act that carry price tags. According to Burke, those opportunities include debates around the deficit, budget crisis and debt limit, efforts to prevent budget sequester from taking place in January 2013 and a desire to reform the way the nation pays physicians, called the “doc fix.”

Despite the hurdles, Tom Daschle, former Senate majority leader, said, “This is a transformation moment.”

“Health reform has seemed an impossibility for decades if not generations,” implored Daschle. “This is our best shot to get it done.”

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