SALT LAKE CITY — A key component of the Affordable Care Act has taken a dramatic turn that is at once both stunning and unsurprising.

In its simplest terms, the original legislation and associated regulations required employers with 50 or more employees to provide health insurance to employees or pay prohibitive penalties beginning in 2014.

Chief Justice John Roberts and the Supreme Court

Health care reform gained significant traction as a consequence of a ruling by the Supreme Court of the United States. In a ruling stunning to Republicans and Democrats alike, Chief Justice John Roberts sided in favor of the individual mandate — a portion of the legislation that requires that virtually all Americans purchase health insurance or pay a fine.

By and large, the Supreme Court decision was a landmark victory for Democrats as well as proponents of expanding the reach of the Commerce Clause.

Republicans clearly drew the short straw at the end of the day, though their rhetoric against the extraordinarily partisan legislation remained strong. In fact, Republicans spearheaded nearly 40 votes to repeal ACA in the House of Representatives. However, since Democrats controlled the Senate and held the presidency, the votes have been paradoxically moot, symbolic and more aligned with the views of the American people.

Related:

Obama admin delays major requirement of health law

In a major concession to business groups, the Obama administration Tuesday unexpectedly announced a one-year delay, until after the 2014 elections, in a central requirement of the new health care law that many companies provide coverage for their workers or face fines.

Public perceptions of health care reform

A June 2013 poll by the Henry J. Kaiser Foundation shows Americans overwhelmingly recognize the need for health insurance while simultaneously fearing the rising costs ACA is designed to tame.

The same poll indicates that "negative views of ACA continue to outpace positive (views)" — though the discord remains partisan with Democrats dissatisfied the law does not go far enough and Republicans upset the law reaches as far as it does.

In short, the country remains divided along partisan lines — only now, Democrats are joining the ranks of those opposed to and confused by the health care reform legislation.

Yet despite the (1) signing of ACA into law, (2) the severe partisanship exhibited by both congressional representatives and the general citizenry, and (3) the Supreme Court ruling, those in the know in both parties are growing increasingly concerned the legislation will not be financially viable and the organic infrastructure required to facilitate such a massive undertaking simply cannot be effectively or efficiently put into place in the time allotted in the original legislation at the original price tag.

Obama administration announcement

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It is in this context that the Obama administration announced on Tuesday the employer insurance requirement for businesses with 50 or more employees will be postponed by a year to Jan. 1, 2015. At the same time, other milestones in a timeline stretching to the end of the decade will continue to take effect.

Adding to the significance of the announcement, the one-year buffer will be interrupted by mid-term elections, likely making health care reform a key issue in the next run up to November.

The announcement by the Obama administration was not a surprise in the sense that it is becoming increasingly clear that at least two of three things need to occur for national health care reform to take hold.

First, there needs to be a pragmatic revision of the legislation itself to ensure financial viability over the long haul. While the Congressional Budget Office insists that a combination of penalty revenues and spending cuts will cut the national deficit, there is both confusion and legitimate criticisms as to whether health care reform can be sustained indefinitely.

Second, there needs to be a serious re-evaluation regarding how much of the legislation is delegated to HHS. Former Utah governor and HHS secretary Michael Leavitt has written of the dangers of placing so much power in this one office.

After visiting the office of one of his HHS predecessors, Leavitt was stunned at the “5-foot-by-10-foot chart” illustrating the new powers given to HHS.

He later reflected in a Washington Post op-ed article, “The new powers of the office are symptomatic of a vast expansion of federal control that, in many cases, usurps state authority and limits private sector autonomy, innovation, and profitability.”

While Leavitt’s association with the Republican Party needs to be acknowledged to view his criticism objectively, much of what he wrote about in 2011 has been realized in the successive two years.

Getting the cart back behind the horse

ACA actually functions at times before the regulations governing the law have been written. While the number of pages of rules and regulations written so far — in addition to approximately 2,600 pages of the actual legislation — is a matter of debate, the Washington Post fact checker estimates there are presently around 13,000 pages of regulations — with many, many more to come.

Related:

How Obamacare will affect your job

Employers around the United States will soon be required to embrace new employment standards intended to bolster health care access to everyday Americans, particularly those currently not covered under employer health benefit programs. The new standards, however, may have unintended consequences for American families.

The debate between Democrats and Republicans as to the proper role of government will go on for a long time to come. Yet one thing that seems objectively clear is that HHS is functioning as a pseudo-legislative body.

Yet even with such expansive power, HHS doesn't have all the answers.

When Utah Gov. Gary Herbert asked HHS for direction on a number of questions, he waited and waited without any answer.

When he finally made contact, he discovered that HHS couldn’t answer his questions because they hadn’t yet read the associated legislation and regulations.

This is a significant challenge.

And while the Obama administration’s modification of the employer insurance penalty timeline is needed, it poses a challenge to local and state governments, nonprofit organizations and businesses that have planned and budgeted, cut employee hours and laid off workers, only to find the resources they redirected to learn how to function in accordance with ACA changed abruptly overnight.

While an extra year is likely to be a buffer needed by each sector of the market, the sudden nature and scope of the change could merely function as a reset button where elected officials, community servants and businessmen and women must determine whether those portions of the ACA timeline that will still be implemented align with their plans. If HHS is going to continue writing these regulations, there must be greater communication — perhaps even synergy — with state governments, innovative medical providers, etc., so that the cart eventually slows to the point it regresses behind the horse where it belongs.

Third, our elected officials must develop the skill of compromise. Without a doubt, these are serious issues. There are times when a line must be drawn in the sand that cannot be crossed. But there is a reason Congress only has a 10 percent approval rating in the latest Gallup Poll. As we elect leaders who are skilled in the arts of civility, tolerance, open-mindedness and peacemaking, we can create, enact and revise ACA as needed.

If we can do at least two of these three things, national health care can still be molded in such a way that Republicans and Democrats, while not fully satisfied, can work together to achieve common goals.

The announcement by the Obama administration took a lot of people off-guard. Doubtless, there will be board rooms across the country filled with panicking executives today and in the coming weeks as governments, nonprofits and businesses work to adapt to such a significant change.

The history of ACA demonstrates why a dramatic change like this was bound to take place at some time. Thus the weighty change is surprising in detail, but not in eventuality. Kurt Manwaring, MPA, focused his graduate research on strategic planning for national health care reform. He maintains a personal blog at www.kurtsperspective.blogspot.com. EMAIL: kurt@manwaringconsulting.com.

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