Writing at Bloomberg Megan McArdle ends her post on the PPACA’s “never-ending fix-a-thon”, the last minute fixes, rule changes, and so on, on a bright note:
Day by day, the administration is putting more of the onus on insurers to make this market work — voluntarily, out of the goodness of their hearts or at least out of mutual self-interest. In some ways, that may be a good thing; insurers are pretty good at delivering insurance, so giving them a freer hand may make sense.
However, her title assumes something that is only an assumption. We should all be able to agree that the PPACA has undergone a hurried “fix-a-thon” since October 1, not just in the incompetently constructed Healthcare.gov but in a host of rules associated with the law, especially as they relate to enrollment.
Megan is assuming that process will be never-ending. The law’s supporters assume precisely the opposite: that the rough edges of the law will be smoothed out through prudent implementation and regulations and that eventually attention can be turned towards expanding the law. For that to happen I think you must further assume that more attention will be paid to the law going ahead than occurred in the past.
I don’t honestly know what will happen. In the new year the small group plans that don’t meet the standards required by the PPACA and its evolving regulations will be eliminated and the waivers issued to large group plans will expire. The law doesn’t come into full effect until 2018 and I don’t think it’s unreasonable to expect that we’ll be seeing revised regulations and hurried fixes until 2020.
Ten years may not be forever but ten years of vacillation between inattention and panicked activity will make it feel as though it were never-ending.
I would assume that there will be constant tinkering and fixing. I think that is true of the vast majority of supporters, or at least those who write on health care. Health care is hard. It will require constant attention. I would hope that we are looking at the next step of reform within the next ten years. That should concentrate on Medicare. There is a lot of low hanging fruit there once we get past the ideology.
Steve
The extent to which the ACA gives the President discretion to make healthcare law is the extent to which the ACA gives future Presidents discretion to remake healthcare law.
Yeah, that’s the “don’t repeal it—just regulate it away” idea that’s been making the rounds lately.
The strength and quality of a marriage, business, government policy/law, largely depends on the quality and strength of the foundation initially built under it. In the case of the PPACA there was not an honest collaboration between parties, nor was the WH trailer, marketing the legislation to the people, at all true or accurate — from the get go. Furthermore, IT professionals see so many flaws in the computer set up, dealing with it’s basic architecture all the way through to it’s inability to funnel info, enroll/bill properly or even have a secure site collecting sensitive, personal data from people trying to sign up for a plan.
But, the computation part of the PPACA is merely a digital disaster, attempting to be fixed by government hires. The real problems lie in the essence of the law itself — one which destabilizes so many peoples’ HC services in order to supply insurance cards to a vastly smaller faction of people. It’s very similar to the ‘creative destruction’ model, employed by Romney to reconfigure/reinvigorate failing businesses — a method roundly criticized and mocked by the dems. However, his business formula was far less ruthless and destructive than the PPACA’s hammer is on present/future cancellations, of so many private/small business/ big business HC plans.
Nonetheless, the real zinger and frustrating part of the PPACA is what many have already said — that having an insurance card doesn’t necessarily guarantee access, especially when exchanges have been so stringently narrowed down to anemic proportions of participating HC services and providers. Even though the government touts medicaid expansion, what difference does it make (citing Hillary), when so many physicians are opting out of taking on sicker patients or those with meager medicaid reimbursements. Previously, people never having HC insurance frequented free clinics and ERs for care. And, if long waiting times arise, to see a doctor for a few paltry minutes, they may simply continue to seek the same familiar places for their medical problems — rendering the insurance card more symbolic than useful. In the meantime, the majority in this country will have undergone a forced remodeling of trusted providers, perhaps medications, subjecting many to higher premiums and deductibles. IMO. there is not much good to be saved in this government plan, with the exception of the preliminary perk of the preexisting conditions waiver.
Apparently, even the uninsured, the very demographic that HC is being turned upside down for, doesn’t like it!