President Obama's re-election ensures the survival of his Patient Protection and Affordable Care Act, but it doesn't mean the law stays without continuing challenges.

Republican challenger Mitt Romney had vowed to repeal the law if elected, calling it a costly government expansion though the massive law was partly based on his own health care reform in Massachusetts.

"President Obama's re-election provides American employers with the referendum to fully begin implementing the Affordable Care Act," says International Foundation of Employee Benefit Plans CEO Michael Wilson. "Even after this summer's Supreme Court ruling, many of our members were still awaiting the outcome of this general election before they addressed health care reform."

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The decision last night cements that it's full steam ahead for the massive and long-panned out law, but it doesn't mean it will be an easy road ahead.

The majority of Americans are still unsure of their feelings on the law and what it means for them, and many experts believe the administration hasn't done a good enough job of explaining it.

The biggest implementations haven't yet gone into effect. There are a couple dozen lawsuits that seek to overturn the contraception mandate, which requires even church-affiliated institutions to cover birth control for their employees.

States also pose threats to the law. State officials have considerable sway over how the law is carried out after the Supreme Court gave them the power to reject the expansion of Medicaid. They are also battling the federal government over the law's new insurance exchanges. Though states are due to give the government a plan detailing how they will roll out their exchange in a matter of days, less than half have begun setting up their exchanges, or have even agreed to do so. The law states that the federal government will set up exchanges in states that haven't.

Unresolved issues

Though the health insurance industry congratulated Obama on his victory, they say cost within the health care industry is still a large and unresolved issue.

"As the health care reform law is implemented, policymakers must prioritize affordability for consumers and employers," says America's Health Insurance Plans president and CEO Karen Ignagni.

"The nation must also address the soaring cost of medical care that is driving up the cost of coverage, taking up a greater share of federal and state budgets, and threatening the long-term solvency of our nation's public safety net programs," she says.

Wilson says it's important to note that PPACA addresses only one of the three broad issues plaguing health care: access. Now, he says, both employers and government will need "more time to address the other two issues: cost and quality of care."

But now that the law is here to stay, businesses will have no other choice but to work with the president on the law's requirements.

For example, the National Retail Federation—which has argued that health reform has threatened the jobs of retailers across the country—said today that they will work with the president in his second term.

"The top issue facing our nation the day after the election is the same as it was the day before the election—the economy," the organization said in a statement. "The U.S. needs public policy that encourages economic growth and removes barriers to job creation." One of those critical issues is to ensure that PPACA actually reduces costs instead of imposing mandates, the federation said.

Brokers moving ahead

Though an Obama victory wasn't what the broker community at large wanted, many say it gives them clarity about the future as well as potential new opportunity.

"I think the best thing to come from last night, professionally, is the clarity that the Affordable Care Act will be implemented, and that we can all get past the excuses and on to the serious business of helping employers with what's to come," says David Smith, vice president of health and welfare benefits at Ebenconcepts in North Carolina.

Just as the Supreme Court ruling that verified the constitutionality of PPACA wasn't the end of the world, neither is the news of Obama's re-election.

Tracy Quick Roseman, a Florida agent who voted for Romney, says she feels she'll always have a place in the industry.

"Did their agencies close overnight? Are all of their clients gone today? Did business stop the moment the 271st electoral college vote was verified? The answer to all of these questions is no and would have been no, no matter what happened yesterday," she says.

"New brokers will enter an industry different than brokers entered a few decades ago just as those brokers entered an industry different than a few decades before that," says Troy Underwood, CEO of Benefits Connect, an online benefits enrollment and administration system based in Rancho Cordova, Calif.

"Employers will need to be navigated through all the changes brought on by PPACA and it's a broker's opportunity and responsibility to be that trusted navigator," Underwood says. "Brokers must get educated on PPACA, implement benefits administration technology for their office and their employers, and explore new products such as voluntary benefits or they should plan on exiting the business." 

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