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Post-election flood of ‘Obamacare’ rules expected

Protesters stand outside the Sandra Day O'Connor Federal Courthouse  Friday, March 23, 2012 in Phoenix. during the Stand Up For Religious Freedom Rally. | AP Photo

The administration also hasn’t finalized rules on certain religious employers. | AP Photo

The bottled-up rules to set up President Barack Obama’s health care reform law are going to start flowing quickly right after Election Day.

But how long will that last? That depends on who wins the presidency.

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The once-steady stream of regulations and rules from the Obama administration — instructions for insurance companies, hospitals and states on how to put the law in place — has slowed to a trickle in recent months in an attempt to avoid controversies before the election. Many states, too, have done little public work to avoid making the law an election issue for state officials on the ballot.

But work has been going on behind the scenes — both in the Department of Health and Human Services and at the state level. As soon as Wednesday, the gears and levers of government bureaucracy are likely to start moving at full speed again.

HHS is expected to begin to release the backlog of regulations. And the states will quickly face a Nov. 16 deadline to tell the Obama administration whether they’ll implement a health insurance exchange — a key part of the law about where consumers will purchase health insurance after 2014.

If Obama wins, that work is likely to continue through the early years of his second term. Democrats will want the law put in place as quickly as possible. They face a late 2013 deadline to have the exchanges ready to go.

And if Romney wins, the need to get the rules out may become even more urgent for Democrats. Any rules or regulations that are not final by Nov. 22 — 60 days before Romney would be sworn in — can be easily put on hold on Jan. 20.

That means the Obama administration would have a huge incentive to have as much of the health law as possible in “final” rule form within two weeks of a Romney victory. Rules and regulations that aren’t final can be more easily changed than those that are.

Susan Dudley, director of the regulatory studies center at The George Washington University and a former administrator of the Office of Information and Regulatory Affairs under President George W. Bush, said the past several presidents have put a stop to as much as they possibly could on Inauguration Day.

“At noon on Jan. 20, one of the first memos out of the chief of staff’s office will be, ‘No regulations get sent to the Federal Register until our appointees look at them,’” Dudley said.

Few significant regulations relating to the health law have come out in recent months. And HHS Secretary Kathleen Sebelius has held fewer news conferences on the law than she did in the first two years after the law passed.

That’s all the more reason that David Merritt, managing director at Leavitt Partners, is expecting a “torrent of regulations” after Election Day.

“I think it’s common knowledge they slow-walked a lot of these. You will see that torrent,” Merritt said. “Will there be enough time for them to become final rules [before a potential Romney inauguration]? Some, probably. Others, probably not. So much is up in the air.”

One of the most important regulations not yet issued is the potentially controversial one to specify what health insurance policies must cover. And final rules have not been issued on other significant pieces of the law, such as those governing the health insurance exchanges, the individual mandate and how to define “full-time” and “part-time” employees in regard to employer penalties.

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