(Save the date: RealShare Medical Office Buildings comes to the Four Seasons in Scottsdale, AZ, November 7 -8 )

WASHINGTON, DC-When the Supreme Court ruled earlier this year that the Affordable Health Care Act was constitutional, the commercial real estate industry had its marching plans for the health-care space. Or so they thought.

Perhaps because it was summer and the presidential election seemed an eternity away, or perhaps because people just wanted certainty, but after the Supremes spoke, there was little discussion about what would happen to the industry if the law were overturned. That changed last night in the presidential debates. Republican nominee Gov. Mitt Romney addressed the subject of the law in no uncertain terms: under his administration he would try to repeal it.

“Is the program so critical it's worth borrowing money from China to pay for it?” he asked, speaking generally about the federal budget and fiscal issues. “If not, I'll get rid of it. Obamacare's on my list.”

He described the plan he would like to create as something that is more affordable--especially for small businesses--and that would be more state-oriented. At the same time, he said, he likes certain elements of Obamacare, such as not allowing insurers to deny coverage to people with pre-existing conditions--provided they have been continuously covered in the past--and keeping young adults on their parents’ plan.

There are more details, of course, and far more nuances between the two plans than can be addressed in this space. But for commercial real estate, the difference, it would seem, is simple: Obamacare versus no Obamacare. Or put another way, the industry has a sense of what the medical office and health care real estate space will look like under a second term for President Obama. But it would be--or so the theory goes--back to the drawing board under a President Romney regime.

Not necessarily, say sources contacted by GlobeSt.com. “Probably the health care space for commercial real estate will look largely the same under either men as president,” Alan Pontius, managing director of the healthcare real estate group for Marcus & Millichap, tells GlobeSt.com. “Look, this is a political debate, but the bottom line remains the same: we have aging demographics and high costs that need to be reigned in. There's no question that demand for services will grow.

“In the end it won't change how investors look at the space," continues Pontius, who will be speaking at the upcoming RealShare Medical Office Buildings Conference in November, "or how they evaluate a given opportunity or the nature of how buildings trade. I don’t expect there to be any reduction in investor demand for quality MOB.”

Jim Kornick, principal at Avison Young, is of the same opinion: "The pressure to reduce costs and drive efficiency will be there regardless of who is president.” There is no going backwards, he says—which is good news for the segment of the industry that invests in health care real estate. “Part of the efficiency push is to move people out of the hospital setting as soon as possible and into community and inpatient settings. That requires different buildings. There will also be more unconventional approaches to delivering medical services, such as in retail settings.”

Count Michael Berne, managing director of National Seniors Housing/Healthcare Group for Lee & Associates, among those that don’t foresee much change--but for a different reason. Berne believes that if President Obama wins a second term he will be forced to make substantial changes to the affordable care act because so many states are reluctant to establish the health care insurance exchanges.

Either way, he tells GlobeSt.com, the new guidelines will be state-generated “although they'll be more so under a Romney administration.” There are other considerations, though, for health care real estate, Joel Ross, principal of Citadel Realty, points out. Namely doctors are making less money and will continue to do so if current trends stay in place.

That is an issue for owners of and investors in medical office buildings, he tells GlobeSt.com. “Medical office groups have less money to pay their bills, and that will continue especially if Medicare reimbursements are reduced.” The industry is heading for a point, he says, where a doctor’s groups will need a balance sheet and bank reference in hand before it signs a lease.