The Supreme Court challenge to the Affordable Care Act (ACA) may have been the most recent obstacle to implementing the healthcare reform law, but it won't be the last, according to a Harvard professor. "The next mortal challenge comes with the Nov. 6 elections," wrote John McDonough, DrPH, of the Harvard School of Public Health. "Although many issues, especially economic ones, will determine the outcomes of the presidential and congressional races, the policy consequences of the election will be most immediately and compellingly felt in connection with healthcare reform," he wrote in a Perspective article published in the New England Journal of Medicine.