The system’s com puter problems have actually obscured the much more significant problems with the law.
In March of 2010, as the debate over pas-sage of the Patient Protection and Affordable Care Act (ACA) was winding down, House Speaker Nancy Pelosi (D-CA) famously said “we have to pass the bill so that you can find out what is in it.”
It has now been nearly four years since the legislation passed, and most of its key components have taken ef-fect, giving us a fair opportunity to “find out what is in it.” The law was deliberately designed so that many of the provisions apt to be most popular would take effect first. Thus, provi-sions such as allowing children to stay on their parents’ policy until age 26 started on September 23, 2010.
However, the law’s key provisions—the individual mandate, prohi-bitions on medical underwriting of preex-isting conditions, subsidies, Medicaid ex-pansion, and the operation of exchanges in all 50 states and the District of Columbia—all started on January 1, 2014. (Another im-portant provision, the employer mandate, was also scheduled to begin on January 1, but the Obama administration postponed the effective date until January 1, 2015.) Recent news coverage has been domi-nated by the “train wreck” that has been the rollout of the exchanges and the computer problems that accompanied it.
However, most of those issues have been corrected. And, as President Barack Obama has repeat-edly reminded us, the health care law is “not just a website. It’s much more.”
In fact, in many ways, the system’s com-puter problems have actually obscured the much more significant problems with the law. Those problems go much deeper than a failed website. They could result in millions of Americans being forced to change insur-ance plans, even if satisfied with their current policy, and in millions more being unable to keep seeing their current doctor (at least not without significant additional expenses). In addition, while there will be both winners and losers when it comes to the cost of insurance, millions of Americans will find themselves paying higher premiums or facing higher out-of-pocket expenses. The law is also likely to slow economic growth and kill jobs. Some of these consequences can already be seen. Others are easily predicted. But some important questions remain. We do not yet know whether the program’s adverse selec-tion problems will be severe enough to cause the entire system to crash and burn. We do not know how doctors will react to systemic changes and reduced reimbursements. And we still don’t know the outcome of legal challenges to the law that are still making their way through the courts.But from everything we can see so far, ACA is turning out to be every bit as bad as critics predicted—or worse.
The Patient Protection and Affordable Care Act
The Patient Protection and Affordable Care Act (ACA), more colloquially known as Obamacare, was more than 2,500 pages and 500,000 words long,
and in the years since its passage, various agencies of government have issued more than 70,000 pages of reg-ulations and guidance to implement it.
It created dozens of new agencies, boards, com-missions, and other government entities.
Several parts of the law have been changed or postponed, often by executive order.
A few provisions have even been repealed or amended by Congress.
It has been both up-held and altered by the courts. And there has been a great deal of misinformation, conjec-ture, and rumor circulating in both the main-stream and alternative media. No wonder, then, that many Americans remain confused by the law itself and its impact on them, their health plans, and their businesses.Despite the complexity of the law itself, and the well-reported difficulties of its im-plementation, ACA boils down to five key components.
As of January 1, 2014, every American is