Since its passage one year ago today, the Patient Protection and Affordable Care Act (PPACA) has been the center of national debate, and the focus of much time and speculation on what the future will hold.
States have brought legal challenges to the law, which will likely be settled by the U.S. Supreme Court. House Republicans have convened hearings, voted to repeal and continue efforts to defund the legislation. Democrats and the Obama administration have engaged in a public relations campaign to educate the general public about the law and boost public support.
Over the last year, we’ve seen portions of the PPACA implemented, with most changes focused on the group and individual market. Many of these consumer friendly changes were aimed at expanding current coverage and, for the most part, were relatively non-controversial. These included:
- Minimum coverage for preventive screenings without cost-sharing
- Adult dependent coverage increased to age 26
- Elimination of lifetime limits on the dollar value of coverage in favor of temporary high annual limits
Major restrictions on policy rescissions
- Grievance and appeals changes
As with any major public policy overhaul, there were stumbling blocks. The Obama administration covertly accelerated the implementation of a requirement that plans must guarantee issuance of policies for children in the individual market. Only a ban on pre-existing conditions for children was to apply this early, but HHS snuck the guaranteed issue provision into regulations for its implementation. This acceleration had major consequences for the individual market, with many insurers dropping child-only coverage altogether and putting stipulations on child coverage for family policies.
While the administration has generally been flexible and cautious with PPACA implementation, this is one case where it was clearly overzealous. It should serve as a cautionary note as the administration begins to implement other tough aspects of health reform, including defining essential benefits.
It is difficult to ignore the fact that millions of Americans do not have access to health insurance. It is almost impossible to deny that this does not have a detrimental impact on our entire healthcare system. Additionally, it’s hard to argue that Americans should not demand higher quality care considering the amount of money paid into the system.
The provisions expanding coverage to the uninsured and rewarding providers, hospitals and health plans for providing high quality care to individuals, which roll out over the next three years, are the core of the PPACA. They are designed specifically to fix the above-cited issues. Therefore, it is no surprise that they represent the most controversial aspects of the legislation. Key to their success is a well thought-out, deliberate implementation by the administration that takes into consideration input from various stakeholders.
Depending on your perspective, as it celebrates its one-year birthday, the PPACA is either on the verge of repeal or merely experiencing the normal growing pains of any major policy overhaul.
The most likely outcome is that some provisions lacking consensus will be repealed or restructured, such as the individual mandate and exchanges. It is highly unlikely that other portions, such as consumer protections and Medicare changes, will be overturned permanently.
We say it’s unlikely that health reform in total will ever go away.