This website has tried to put various aspects of the Affordable Care Act (ACA) into easy to understand and concise language. The complexity of the 2700 page legislative language as well as the over 10,000 pages of regulations that fill in the framework of the legislation, make smaller bites more practical to address, the reason behind most media coverage. However, the big picture is also important to consider. The ACA is a seminal piece of legislation in our country’s history, and on the level of the New Deal and the Great Society programs of the past. Putting this into context will be the thrust of the next few columns.
There can be no argument that the healthcare delivery system in the United States is unwieldy at best, and broken at worst. Inconsistencies abound across the country with care, access, and health insurance coverage. Cost has skyrocketed for services that only a generation ago were about the cost of a week’s groceries, while advances in medicine have made once fatal diagnoses curable. Our aging population is living past the life expectancies of many pension plans, and Medicare and Medicaid are increasingly picking up the tab for those once able to pay for basic medical services as well as long term care on their own. The legal system has introduced lawsuits which have made many providers leery of treating patients without a host of backup tests and procedures. This is called defensive medicine. Physicians are leaving private practice due to increased malpractice insurance rates and high overhead stemming from skyrocketing costs.
Something had to be done, and after years of talking about it, Congress acted and President Obama signed the Affordable Care Act on March 23, 2010. The law put into place comprehensive health insurance reforms that would be implemented over ten years and beyond. The nature of its passage was controversial, but few could argue that the current system was working. Partisan bickering reached a fever pitch in the countdown to the final vote, and yielded perhaps the most memorable line of the whole debate when House Speaker Nancy Pelosi, a fervent supporter of the legislation, said, “…We have to pass the legislation in order to know what is in it.” A prophetic line indeed, since the bill’s framework left critical details to those in the federal bureaucracy, mostly the Department of Health and Human Services.
This year is the third year of the ACA implementation, and as regulations are being written and deadlines met, the changes are already in evidence. The Patient’s Bill of Rights, electronic exchange of health information, extended coverage for young adults, and increased coverage for preventative care are some examples. This year deadlines include the creation of health insurance exchanges, standardized billing and electronic health records that link hospital payments to quality outcomes, and incentives for integrated health systems called “Accountable Care Organizations”.
Obviously there is much to discuss, so this column will be the first of a series aimed at providing the reader with an overview of the ACA. The next column will go into more detail about upcoming deadlines, and what they will entail. Subsequent columns will deal with future implementation with a few tongue in cheek scenarios to illustrate the changes to come, so be sure to check back.
These sources provide more detail about the ACA implementation process.