Should President Obama win a second term, there is little to wonder about his administration’s plans for the health care industry. The president has shown his hand since the Affordable Care Act was enacted in 2010, and plenty of provisions remain to be implemented.

But what happens if Gov. Mitt Romney prevails on November 6? The answers are much less clear.

Romney’s campaign Web site lays out his health care in the vaguest of terms. He spent the primary campaign season promising to repeal ObamaCare on his first day in office. That softened during the general election campaign--on his first day, President Romney would sign an executive order to issue ObamaCare waivers to all states, and then work with Congress to repeal the entire law as quickly as possible. In recent weeks, that has further softened, as he notes some provisions of the reform law would remain, such as coverage for adult children up to age 26 and prohibiting discrimination against individuals with pre-existing conditions who maintain continuous health insurance coverage. The current law requires coverage of persons with preexisting conditions, many of whom previously have not been able to get insurance.

Romney would halt the expansion of Medicaid under the reform law, giving states block grants with more flexibility to mold their programs, such as restricting eligibility or benefits. What the Web site leaves out is that the grants, starting with a $100 billion cut in Medicaid in 2013, would reduce Medicaid spending by more than $1.7 trillion--$932 billion from repealing expansion and $810 billion from spending cuts, according to Kaiser Health News.

But what would happen to reform-fostered accountable care organizations with their heavy reliance on electronic health records, data analytics and health information exchange, and operating rules to make HIPAA administrative/financial transactions more standardized? Here are the complete answers on the Romney Web site: “Promote alternatives to fee-for-service” and “Facilitate IT interoperability.”

So there are campaign promises with vague specifics, and there are the political and real-world realities that will confront Romney should we call him “Mr. President” on January 20, 2013.

Health care payment reforms and ACOs have wide bi-partisan support in Congress, notes Chris Condeluci, an attorney with the law firm Venable LLP in Washington, D.C., and a former GOP tax counsel for the Senate Finance Committee during the drafting of the Affordable Care Act. “I could very well see these being put back into the law,” he says.

Government support for health information technology would continue under a Romney presidency, Condeluci predicts, as policymakers would continue to support implementation of electronic health records, among other technologies.

But changes could come to the EHR meaningful use program, the merits of which some GOP leaders in Congress are beginning to question. They want to know if use of EHRs is resulting in upcoding of claims and higher payments from Medicare, and if real benefits are resulting from the billions of dollars in incentive payments attached to EHR adoption.

The congressional concerns, real or not, will continue for some time, Condeluci believes. “Congress waves a red flag then tries to figure out if the flag is a red herring, and that process needs to play out. In the deficit reduction environment we’re in, anything that is taxpayer funded that has even some semblance of question of whether it’s justified to allow taxpayer funds to promote this policy would be under the microscope and could be rolled back or eliminated.”

Mandated and taxpayer-funded health insurance exchanges would be dead. But the concept of the exchanges also has bipartisan support and Condeluci says some type of HIX would be around, “it’s just a matter of how it is done.”

A Romney administration could build off private insurance exchanges already in the market, or adopt a laissez-faire approach to exchanges, such as modeling them after an existing one in Utah that is voluntary. Insurance exchanges would not be housed in a government agency or supported by government. Taxpayer-funded premium subsidies to help buy insurance through an exchange would be reduced and focused on lower-income individuals and families; Condeluci says a family of four making $90,000 to $100,000 can get a subsidy today under ObamaCare.

He envisions the exchanges would have limited restrictions on the types of plans offered through them--in contrast to ObamaCare which has standards that plans must meet to become “qualified health plans.”

Overall, Condeluci believes Romney would have more realism about what an insurance policy can cover and what can be afforded. “Instead of requiring everything under the sun, maybe so long as all have catastrophic coverage, individuals can customize their choices.”

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