Now that the votes are counted (almost all of them, anyway) and President Obama has a second term, what does it mean for seniors?

While President Obama's re-election means Medicare and
Medicaid as we know them will likely be preserved at least for the next four
years, many challenges are still ahead.  

One of the biggest outcomes of the election is that the
Affordable Care Act (ACA – a.k.a. "Obamacare"), which candidate Mitt
Romney had promised to repeal, will almost certainly remain as law and be fully
implemented.  The law is already beginning to close the gap in Medicare’s
prescription drug coverage known as the "doughnut hole," as well as
providing free preventative care for Medicare recipients. The ACA also included
a number of provisions aimed at improving long-term care and helping recipients
remain in their homes rather than be forced into nursing homes, and these will
continue to be carried out.

There may be some issues ahead, however.  Before the
end of the year, Congress will try to avoid going over the "fiscal
cliff," which is what will happen if it fails to act on continuing at
least some of the Bush-era tax cuts and fails to prevent automatic spending
cuts that it agreed to as part of last year's deficit reduction deal.
 Many economists believe that the combination of the two could send the
fragile economy back into recession.  Lawmakers are now trying to agree on
a "grand bargian," alternative spending and revenue measures that
will will help reduce the deficit while not damaging the economy. 

Although Medicare and Medicaid will likely maintain their
current structures, cuts may be made during these negotiations or later. The
President still has to deal with a Republican majority in the House of
Representatives, many of whom want to cut spending and entitlement programs.

President Obama reportedly offered to increase the Medicare
age to 67 in last year’s budget negotiations with Republicans.  In
addition, many are worried that the President may be inclined to cut Social
Security benefits as well during fiscal cliff negotiations, according to a
recent policy update from the National Academy of Elder Law Attorneys.
 During the first debate, the President said his position on Social
Security did not differ markedly from Governor Romney's.  Romney supported
raising the retirement age and privatizing Social Security benefits.  

“There is going to be the fight of our lifetime to maintain
Social Security, Medicare and Medicaid,” says Eric Kingson, a professor of
social work at Syracuse University quoted in a Huffington Post article titled "Obama's Second
Term and Older Americans."

According to a Reuters article, congressional
Republicans are also expected to ask for concessions from the ACA, including
delaying and scaling back the planned expansion of Medicaid.  In addition,
state lawmakers, many of whom are Republican, will decide how the ACA is
carried out. Thirty states have Republican governors, some of whom have said
that they will opt out of the Medicaid expansion provided for in the ACA.
But President Obama's re-election may boost the prospects for expansion.
According to Kaiser Health News, his win may prod reluctant states
to move forward with the expansion.