In contrast, the election of Governor Romney could lead to repeal and/or defunding of important elements of the ACA, especially if Republicans control both houses of the Congress, which is possible. Even if Republicans do not control the federal legislature, a future President Romney could profoundly redirect, slow, or stop altogether the implementation of major elements of the ACA. For example, the President has considerable discretion in how vigorously to use the federal government's authority under the ACA to set up health insurance exchanges in states that don't choose to do so themselves and in how to use ACA authorities to regulate private insurance practices that could discriminate against sick and high-cost patients. Given the Governor's announced support for state flexibility and discretion, he seems unlikely to encroach aggressively on the states' freedom to manage their own health insurance markets. The likely result is that many fewer Americans may have the ability to purchase private insurance through state health insurance exchanges under a Romney administration than under President Obama. A Romney administration is also likely to impose fewer constraints on the sale and pricing of private insurance plans, such as federal regulations preventing insurers from discriminating against sick and costly patients.