The GOP takeover of the U.S. Senate and gains in the House of Representatives are unlikely to fully derail Obamacare, experts predicted during a panel discussion on Nov. 6 that was covered by the Philadelphia Inquirer and WHYY.

The Affordable Care Act, which survived President Obama’s rough 2012 re-election and other obstacles is like a cat with nine lives, said Robert Field, professor of law, professor of health management and policy, and founder and editor of The Field Clinic blog, which co-sponsored the discussion, along with the Philadelphia Inquirer.

The mid-term elections might represent the law’s tenth life, said Field, moderating the discussion with several of the contributors to The Field Clinic.

The Republicans’ widespread victories will inevitably force President Obama to accept changes to the sweeping law, said Mark V. Pauly, the Bendheim Professor in the Department of Health Care Management and Professor of Business Economics and Public Policy at the Wharton School.

With the medical device tax drawing bipartisan opposition, Pauly said, changes are in store for that provision of the law.   But since Republicans lack a big enough majority to overcome a filibuster or presidential veto, Pauly said, the GOP does not and should not expect to repeal the law or its core component, the individual mandate.

Pauly called vows by GOP leadership to propose repeal legislation “mostly cosmetic,” since there are components of Obamacare that many Republicans can readily live with.

In Pennsylvania, enrollments for the health care coverage program crafted by outgoing Gov. Tom Corbett are scheduled to launch on Dec. 1, just before Governor-elect Tom Wolf takes office.

The incoming governor has the power to restore benefits that Corbett’s program cut, said Antoinette Kraus, director of the Pennsylvania Health Access Network, the state’s largest statewide health coalition.

“We’re creating a complex system that creates barriers to access at the same time as hurting our most vulnerable citizens,” Kraus said of Corbett’s program. “Wolf’s advisors say they’re for full Medicaid expansion. We’re urging (Wolf) to do so as soon as possible.”

With the federal dollars available to states that start their own health care exchanges, Pauly said, Republican-led states may be tempted to grab funds to launch exchanges that they can craft to their own ends.  Republicans will favor exchanges that are unburdened by regulations, he said.

Paula Stillman, a health care consultant and former vice president of health services at the Temple University Health System identified a host of lingering issues that must be addressed to make health care more cost effective.

“We should be giving providers and patients incentives for controlling costs,” Stillman said, adding that doctors have little reason to do more than schedule brief visits with patients and then refer them to specialists. 

While guidelines have been offered for measuring the quality of care, Stillman said, it’s not clear that the guidelines themselves are the right ones.

Cost pressures will drive a consolidation of health care systems in the region and greater collaboration among providers, Stillman predicted.  

“In a city the size of Philly, we don’t need to support seven cardiac programs,” she said. “High-end services will wind up in a few sites that can support that infrastructure.”

Noting the controversy that has greeted health care reforms sought by presidents from FDR to Bill Clinton, Field said the mid-term elections reflect a seemingly endless and epic opera.

“We think the fat lady is about to sing,” Field said, “but there’s another act to go.”