In a second term, President Barack Obama is expected to continue implementing the health care reform law he signed in 2010, with most major changes to take effect in 2014.
When fully established, the new system is expected to reduce the number of uninsured Americans from about 50 million to about 24 million.
Although the Republican-controlled House has repeatedly voted to overturn the law over concerns that it is too expensive and intrusive, a Democratic Senate has refused to consider any rollback.
Broader budget and tax battles may determine how much money is available to encourage states to expand their Medicaid programs -- the U.S. Supreme Court has ruled they don't have to enlarge them, and some will not -- but the mandate requiring most people to either buy insurance or pay a penalty will survive.
Other insurance changes, like bans on annual or lifetime coverage limits and guaranteed coverage regardless of health status, will take full effect in 2014. New regulations for provisions expected to save money will take priority.
Though state health insurance exchanges are due to be established by Jan. 1, 2014, many Republican governors have resisted, forcing the U.S. Department of Health and Human Services either to allow delays or to permit states to partner with the federal government in running the exchanges from which individuals and small businesses are supposed to purchase policies.
A second Obama term will maintain spending cuts to Medicare -- $716 billion over 10 years, primarily in reduced reimbursements to providers -- although Congress will press for other changes. Perhaps it will raise patients' eligibility age for full coverage or impose income limits.
Written by Lee Bowman, Scripps Howard News Service