Though the election results have not provided instant clarity to the healthcare reform issue, a light at the end of this very long tunnel is finally in sight. It may, however, be a very bumpy ride getting there.

With the status quo essentially remaining in place in both the White House and Congress, the Affordable Care Act (ACA) will continue toward full implementation in 2014; repealing the ACA is essentially no longer in play thanks to President Obama's victory in yesterday's election.

During the campaign, the Obama Administration essentially stopped most Affordable Care Act regulations from being released, mainly to prevent political attacks from having an effect on the election. Now that the election is decided, the Administration is expected to finally release these much-anticipated regulations implementing provisions of the ACA, with the major provisions slated to become effective on January 1, 2014. Both states and other stakeholders have asked for sufficient time to respond to the regulations once they are issued, and so an actual implementation date may not come until several months later.

Federal spending on entitlement programs (essentially Medicare, Medicaid, Social Security, and as of June 2012, the Affordable Care Act) continues to grow at levels that most consider to be unsustainable. Policymakers on both sides of the aisle agree that government spending on these programs needs to get under control, but largely disagree on how to achieve it; the election results have provided no easy relief to this issue. The entitlement reform debate is most likely to get very contetnious before it becomes clear.

President Obama has proposed reforming entitlement programs as part of his plan to achieve deficit reduction over the next decade through reducing fraud, waste, and abuse, encouraging greater provider efficiency, and continuing to implement delivery system payment reforms that improve quality while reducing costs. But will those measures be enough to save the president's proposed $4 trillion? Through the ACA, the basic structure of Medicare is preserved (despite many changes to the process) and the Department of Health and Human Services has been given much leeway to test new payment plans. Political opposition will, of course, still factor in.