PPACA’s One Year Anniversary – In Retrospect

from BenefitMall (Michael Gomes)

This week marks the one-year anniversary of the Patient Protection and Affordable Care Act (PPACA), which was passed and signed into law on March 23, 2010. The primary reason for the passage of the Act was to address many of the delivery and quality health care short-comings in America, whether real or imagined. Currently, the law is being implemented across multiple agencies within the federal and state governments.

Stages of Implementation

Several federal agencies, including the U.S. Departments of Labor, Education, Justice, and Health and Human Services (HHS), were called on to begin the implementation process for PPACA immediately after the President signed the bill into law. In addition, governors, state legislatures and regulatory branches are now charged with implementing some of the reforms, including the creation of state-run health care exchanges.

Due to the sometimes vague nature of PPACA, the federal regulatory process is ongoing and will continue for years to come. To date, many key provisions have already been enacted. Some of those are:

  • Extending the age of adult children eligible for coverage under their parents’ health care plan to age 26
  • Prohibiting individual and group health plans from placing lifetime limits on the dollar value of coverage
  • Preventing health insurers from rescinding coverage (except in cases of fraud)
  • Prohibiting health insurers from imposing  pre-existing condition exclusions for children
  • Mandating coverage for recommended immunizations and preventive care

PPACA also established new offices and programs at HHS such as the Office of Consumer Information and Insurance Oversight (OCIIO)1 and the Patient-Centered Outcomes Research Institute (PCORI)2. In addition to creating new organizations, PPACA also calls for the expansion of the Center for Medicare and Medicaid Services Innovation Center among other initiatives.3

Political & Legal Turmoil

The passage of PPACA in March 2010 prior to the November elections created a dramatic effect on America’s political landscape. Propelled by a somewhat skeptical electorate that doubted the potential benefits and the cost of the Act, Republicans took majority control of the U.S. House of Representatives and cut into the Democratic majority in the U.S. Senate. As a result, House Republicans were able to pass H.R. 1, a measure that would repeal PPACA in its entirety. Though the legislation failed in the Democrat-controlled Senate, 200 separate bills have been introduced in the House to address, repeal or defund elements of the Act as Republicans take a mostly symbolic stand against health care reform.

In addition, a host of lawsuits have been filed in an attempt to declare some or all parts of the President’s reform bill unconstitutional. One such argument holds that PPACA is unconstitutional due to its violation of an Interstate Commerce clause that somewhat restricts the federal government’s ability to control states and individuals. One case in particular was filed by more than 26 state attorneys general, and a district judge declared the Act unconstitutional (an appeal is currently in progress) in this trial. Another judge ruled against the Act’s constitutionality due to the lack of a severability clause, which holds that if one section of a piece of legislation is declared unconstitutional, it does not void the rest of the legislation. Since PPACA did not include this clause, it was found unconstitutional as a whole. Three other judges have upheld the legality of PPACA. It is anticipated this case will be heard by the U.S. Supreme Court prior to the 2012 elections.

The timing of these lawsuits is particularly problematic for PPACA supporters. Proponents of the Act promised that as the American public became more familiar with the Act, they would come to accept it. That has not happened. Polls continue to reflect a great deal of skepticism, with 55% of Americans opposing the law at its inception, while recent polls indicate that the negative sentiment has only increased. Polls now show as many as 62% of Americans favor the repeal of the law.4 Declining public support continues to be an area of significant concern for the President. White House staff continues to try to change public opinion by deploying experts to educate the public on the law’s benefits. To date, they have been largely unsuccessful in their efforts.

The Future of Health Reform in America

If the U.S. Supreme Court hears the cases on the constitutionality of PPACA and issues an opinion later this year as anticipated by some legal experts, health reform promises to become one of the preeminent issues in the 2012 elections. Early election polling hints at expanding public opposition to PPACA, which does not bode well for Democrats who are up for re-election.

The insurance marketplace has been dramatically altered in the past year due to PPACA. More provisions addressing Medicare and Medicaid, long-term care and quality of care are expected to be rolled out, but the timeline for complete implementation of the law continues to stretch past 2018. In addition, states are expected to adopt a wide range of exchange models before 2014. Limitations on funding both at the federal and state levels will need to be addressed to avoid a rise in government deficit levels.

At the same time, world events could impact how government officials and policymakers move forward with changing the U.S. health care system. Natural disasters, political conflicts abroad, fluctuations in the global economy and local markets, for example, can create distractions, which may lead policymakers to adopt an incremental approach to revamping the U.S. health care system.

In the short term, PPACA will continue to face significant political and legal hurdles. Nonetheless, implementation will continue, with more provisions and offices becoming established under the law.

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As more information becomes available, BenefitMall is committed to keeping you up-to-date in a timely manner. Visit www.BenefitMall.com to view past Legislative Alerts in the “Newsroom” section. Or, you may visit www.HealthcareExchange.com for blog posts, polls, surveys and numerous resources. If you have any questions, please contact your local BenefitMall Sales Team and they will be happy to assist you. Thank you for taking the time to read through this important notification.

The views expressed in this legislative alert do not necessarily reflect the official policy, position, or opinions of BenefitMall. This update is provided for informational purposes. Please consult with a licensed accountant or attorney regarding any legal and tax matters discussed herein.



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