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A New Era in Healthcare

May 1, 2010 | Comments Off on A New Era in Healthcare
Posted by Frank Ciesla

The recently passed Patient Protection and Affordable Care Act and the Healthcare and Education Record Act of 2010 (hereinafter jointly “PPACA”) will impact employers, employees, their dependents, insurance companies, healthcare providers and state agencies at a minimum.  While PPACA consists of over 2,000 pages, the implementation of PPACA will require, by the terms of PPACA itself, an extensive time period, as well as substantial, detailed and controversial regulatory implementation.

In light of the extended implementation time frame, there clearly will be many authors participating in the implementation process.  The implementation will undoubtedly be subject to future congressional action.  In addition, the composition of the Congress will change significantly through retirements, lost elections, or deaths.  What is not clear is the various approaches that may be taken by the future Congresses to issues that present themselves during this implementation stage.

Moreover, whether or not President Obama is re-elected to a second term, portions of the implementation will occur after he has completed his Presidency.  Therefore, the potential impact of a change in administration could further alter the implementation landscape.

A substantial part of the implementation will occur pursuant to the administrative process.  The estimated number of pages of regulations necessary to implement PPACA is constantly growing, from 10,000 pages to over 60,000 pages, at the federal level involving at least three regulatory agencies, the Centers for Medicare and Medicaid Service, the Internal Revenue Service and the Department of Labor.  The identity of the regulators who participate in the administrative process during the implementation period will also change over time, which may result in a modification of both philosophy and approach.  In addition, the implementation process may be impacted by: (1) future legislation, (2) budgetary constraints, (3) unforeseen consequences, (4) independent actions, and (5) the conflict between the approach of the various states and the federal government, which will impact the ability to carry through the implementation of PPACA.

The role and composition of the judiciary and legal challenges to PPACA will also impact implementation of the legislation.

In addition, the responses of employers, unions, federal agencies, and state agencies, as well as the conduct of providers, payors, and individuals, cannot be expected to be uniform, resulting in many permutations that will impact each stage of implementation.

There are many charts, outlines, and analyses currently available as to what is proposed in the implementation schedule.  However, most utilize a common caveat which specifies that the proposals in many instances are vague.

In addition to this action at the federal level, while it is not now clear what statutory and regulatory actions the State will take both in reaction to the actions at the federal level, and also to implement the actions at the federal level, it is certain that they will be taking actions over the years.

As a firm, we expect to comment over the extended implementation period as various issues develop and impact our clients.  As the magazine of the Healthcare Financial Management Association, reported in its April 2010 issue:

“Gen. Colin Powell says that the time to act is when you’re between 40 and 70 percent sure of an event.  If you act before you have 40 percent certainty, you have insufficient knowledge, and after you have 70 percent certainty, it’s too late for meaningful action.”

While many changes and many responses will be required going forward, no one today can set forth what those changes and responses will be.

Through this site, we will share our thoughts as to the ongoing implementation.  We hope that you will join us on what undoubtedly will be an interesting journey.


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