President Barack Obama was re-elected last night, and his win means that the Affordable Care Act will not be overhauled. Despite the fact that the Affordable Care Act had largely been upheld by the Supreme Court in a landmark decision in June, Republicans in Congress had vowed to dismantle the bill. Presidential candidate Mitt Romney had sworn to repeal most of the bill, even though it was modeled after healthcare reform put into place in Massachusetts during his tenure as governor. However, challenges still remain.

The Affordable Care Act was intended to provide insurance coverage to 30 million uninsured Americans. Half of those uninsured Americans were supposed to be covered under expansion of Medicaid, a healthcare program intended to give medical coverage to the poor. Even though the federal government would pay for additional enrollees to the program until 2016 and 90 percent of the cost for additional enrollees each year thereafter, six states with Republican governors have announced that they will not expand Medicaid: Florida, Georgia, Louisiana, Mississippi, South Carolina, and Texas. Many states had taken a wait-and-see approach as well. Republicans will be taking residence in 30 governor's mansions across the country.

Regardless of the states' positions on Medicaid, the states all have nine days to implement a plan for state-run insurance exchanges, where consumers can shop for insurance plans across state lines. If they do not issue a plan by November 19, the federal government will take over their insurance exchanges.

"The message to governors is the verdict is now in," Ron Pollack, the executive director of Families USA and a proponent for the act, said to Bloomberg, "Either they help cooperate with its implementation, or people in their state could be left out in the cold."

Thirty-four states have received two grants from the federal government in order to start planning an exchange. About 20 states will partner with the federal government in order to create the insurance exchange. An additional 13 states say that they will run their own. As of now, the exchanges will go into effect in 2014.

Analysts believe that, with the threat of repeal no longer looming, President Obama may be more flexible with states or delay implementation of some of the act's provisions. Analysts doubt that few states will allow the federal government to take over the exchange in their state.

The law will be covered with tax increases, spending cuts, and a debt limit. It will also subsidize the cost of insurance coverage for families earning up to four times the poverty level: $92,500 for a family of four.

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