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SALT LAKE CITY -- The technical aspects of health care reform could be called a work in progress.
Before the Affordable Care Act was signed into law, questions abounded as to what was actually in the legislation. And at least for the general public, there weren’t a lot of answers.
In 2010, House Speaker Nancy Pelosi addressed the National Association of Counties. While extolling the virtues of what would become the Affordable Care Act, she also stated, “We have to pass the bill so that you can find out what is in it.”
The bill was passed a few weeks later, but questions still remain about what is in the legislation.
The genesis for this continued uncertainty is likely a result of three factors. First, the final bill weighed in at more than 2,400 pages, and it is certainly not what anybody would refer to as easy reading. Second, rumors about the legislation — some true, some not — have incited fear and led many groups and individuals to spread information about the bill which came from second- hand sources rather than the actual legislation. Third, and perhaps most importantly, the health care bill isn’t complete yet even though it has already been signed into law.
Legislation comes in all shapes and sizes and health care reform happens to be one of those bills that are very large. While font size makes a difference in comparing one book to another, reading the health care bill from cover to cover is something akin to reading the entirety of the Bible or Tolstoy’s "War and Peace." Yet even reading the bill isn’t a guarantee that it will also be understood. The sheer length and complexity of the legislation is one reason why questions abound as to what is in it.
Rumors about the legislation also impede efforts to understand it how it works. Some of the most popular myths surrounding the legislation will be covered in the eighth article of the series — and the content may be surprising to those on both sides of the political aisle.
Perhaps the greatest obstacle to understanding the legislation is the fact that it is still a work in progress. Much of the functional content of the legislation will be produced by the Secretary of Health and Human Services. In some ways, the Affordable Care Act could be viewed as an outline — albeit a very long outline — and the HHS regulations (most of which have yet to be released) could be thought of as the actual text.
And there will be a lot of regulations. The health care reform bill contains almost 2,000 declarations in which responsibility for actionable content of the legislation is delegated to HHS. This creates a problem for governments and organizations which know that changes will be needed in vital areas but don’t know what those changes will be.
We have to pass the bill so that you can find out what is in it.
–Nancy Pelosi
The Affordable Care Act lays out the specifications relative to when the changes will take effect, but what the changes actually entail still remain largely unknown. To date, only two regulations have been released by HHS. To help aid the process, the department periodically publishes lists of frequently asked questions to assist organizations which are trying to cope with the uncertainty.
To complicate matters further, the anticipated regulations released by HHS are trending in such a way that they will likely total far more pages than the already-intimidating 2,400-page Affordable Care Act.
The confusion surrounding how the health care legislation actually works thus becomes easy to understand. The legislation is very long. Alarmist rumors cloud the issue. And most importantly, the legislation isn’t technically complete yet.
In fact, while it’s unlikely, if the length of the regulations continues at its current pace, the totality of the legislation — not counting any potential new amendments — would equal more than 170,000 pages (by comparison, the tax code, Title 26 of the U.S. Code of Federal Regulations, is approximately 13,000 pages). When all of the details are in place, the original legislation could possibly turn out to be the page-number equivalent of a short story.
Nevertheless, there are important details about how the legislation works which are exceedingly clear.
Some aspects of the legislation have already gone into effect.
For example, shortly after the legislation became law several significant changes were implemented to make health insurance available to more people. These changes include enabling uninsured adults with preexisting conditions to get insurance in a “high risk” pool, prohibiting insurance companies from rejecting children with preexisting conditions, and allowing adult children under the age of 27 to remain on their parent’s insurance.
Various provisions of the Affordable Care Act will be implemented over the course of the next seven years. The year of most relevance to the general public is 2014.
In 2014, two of the most significant aspects of health care reform will go into effect.
First, individuals without insurance will be required to purchase it — or face a fine. Aside from the failed “public option” which would have created a government-run insurance plan, the provision to force individuals to purchase insurance is perhaps the single most controversial aspect of the Affordable Care Act. This requirement is often referred to as the “individual mandate.”
Second, a virtual market for health insurance will be created in every state. These markets are called insurance exchanges and will be a new venue where many individuals can purchase insurance. The exchanges are designed not only to lower the cost of insurance but also to simplify the complicated process of determining which plans are best suited to meet individual circumstances.
The individual mandate and state insurance exchanges will be the subject of the next two articles in this series.
This is the third in a series of nine articles addressing the topic of health care reform.
Kurt Manwaring is pursuing a graduate degree in public administration at the University of Utah. He is the owner of Manwaring Research & Consulting and maintains a personal blog at www.kurtsperspective.blogspot.com.
