Wednesday, March 23, 2011

Today marks the one-year anniversary of the Patient Protection and Affordable Care Act (PPACA), which was passed and signed into law on March 23, 2010. The primary reason for the passage of the Act was to address many of the delivery and quality health care short-comings in America, whether real or imagined. Currently, the law is being implemented across multiple agencies within the federal and state governments.
Stages of Implementation
Several federal agencies, including the U.S. Departments of Labor, Education, Justice, and Health and Human Services (HHS), were called on to begin the implementation process for PPACA immediately after the President signed the bill into law. In addition, governors, state legislatures and regulatory branches are now charged with implementing some of the reforms, including the creation of state-run health care exchanges.
Due to the sometimes vague nature of PPACA, the federal regulatory process is ongoing and will continue for years to come. To date, many key provisions have already been enacted. Some of those are:
Extending the age of adult children eligible for coverage under their parents’ health care plan to age 26
Prohibiting individual and group health plans from placing lifetime limits on the dollar value of coverage
Preventing health insurers from rescinding coverage (except in cases of fraud)
Prohibiting health insurers from imposing pre-existing condition exclusions for children
Mandating coverage for recommended immunizations and preventive care
PPACA also established new offices and programs at HHS such as the Office of Consumer Information and Insurance Oversight (OCIIO)1 and the Patient-Centered Outcomes Research Institute (PCORI)2. In addition to creating new organizations, PPACA also calls for the expansion of the Center for Medicare and Medicaid Services Innovation Center among other initiatives.3
Political & Legal Turmoil
The passage of PPACA in March 2010 prior to the November elections created a dramatic effect on America’s political landscape. Propelled by a somewhat skeptical electorate that doubted the potential benefits and the cost of the Act, Republicans took majority control of the U.S. House of Representatives and cut into the Democratic majority in the U.S. Senate. As a result, House Republicans were able to pass H.R. 1, a measure that would repeal PPACA in its entirety. Though the legislation failed in the Democrat-controlled Senate, 200 separate bills have been introduced in the House to address, repeal or defund elements of the Act as Republicans take a mostly symbolic stand against health care reform.
In addition, a host of lawsuits have been filed in an attempt to declare some or all parts of the President’s reform bill unconstitutional. One such argument holds that PPACA is unconstitutional due to its violation of an Interstate Commerce clause that somewhat restricts the federal government’s ability to control states and individuals. One case in particular was filed by more than 26 state attorneys general, and a district judge declared the Act unconstitutional (an appeal is currently in progress) in this trial. Another judge ruled against the Act’s constitutionality due to the lack of a severability clause, which holds that if one section of a piece of legislation is declared unconstitutional, it does not void the rest of the legislation. Since PPACA did not include this clause, it was found unconstitutional as a whole. Three other judges have upheld the legality of PPACA. It is anticipated this case will be heard by the U.S. Supreme Court prior to the 2012 elections.