Putting the Affordable Care Act Into Action

Evaluating Obamacare: 2010 to Summer 2013

By Ferd Mitchell and Cheryl Mitchell

The Affordable Care Act (aka Obamacare) was passed by Congress in March, 2010. (FN1) This very complex new law placed urgent and wide-ranging administrative requirements on federal agencies to move ahead with implementation activities.. Within the next few months, the administrative demands rapidly spread to state agencies, and motivated a wide range of  organizations involved in the health care system (including employers, insurance companies, and providers) to begin their own response activities.

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During 2012-2013, development of the Health Benefit Exchange organizations (to provide a health insurance marketplace) began to take shape, with 16 states and the District of Columbia now planning their own Exchanges and with federal agencies to provide Exchange operations for other states (with 7 states planning on partnership Exchanges and 27 states deferring to all-federal responsibility for their Exchanges).

Now, during the summer of 2013, administrative activities are spreading to the local level as major efforts are made to develop a “navigator” program to assist the public with enrollment for health insurance through the new Exchanges.

At each of these stages (and levels) of development, new requirements have been placed on administrators. At the federal level, emphasis has been on planning for program implementation; the development of policies, procedures and regulations; and problem solving during the transition period. These agencies have also been required to learn how to cope with a highly partisan political environment that has produced constant pressure on administrators.

Early in the implementation effort, private-sector organizations began to assess their own financial interests and preferences, and options likely to become available under the ACA. Large-scale efforts by these organizations throughout the 2010-2013 transition period have been directed toward the development of new modes of operation that have seemed most likely to maximize organizational success.

At the state level, the matching emphasis regarding the Exchanges has been on the analysis of federal requirements and guidance;

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trying to structure state responses; and coping with in-state political pressures. Where Medicaid programs are being expanded to cover many more low-income adults, adjustments to these changes are also under way; 22 states and the District of Columbia plan to expand their Medicaid programs, 3 are exploring alternative approaches, and 25 are undecided or have decided not to proceed for now.

At the local level, emphasis is now shifting from watching the above efforts (through various media) to the activities of those public and private organizations that are becoming involved in efforts to enroll individuals for insurance through the new Exchanges.

The combined efforts are now nearing the first reactions by the public, with the Exchanges scheduled to become operational on October 1, 2013. Both the new insurance options (in all states, through a combination of state and federal Exchanges) and expanded Medicaid programs (in states that have chosen to participate) are to become effective on January 1, 2014.

As might be expected, the federal requirements for implementation of the ACA continue to evolve rapidly. Thus, all administrative activities must adapt constantly to a new environment. At the same time, there are set deadlines that do not seem likely to change, and political discourse over the ACA remains at an intense level.

The result has been the creation of unique administrative settings for both public and private organizations. New methods and procedures for program administration are having to be developed “on the fly”, leading to the creation of a rich and diverse information base regarding the administrative strategies that are being attempted.

In the months to come, internal and external evaluations will begin to assess the successes and failures associated with various administrative efforts in this intense environment, and to draw generalized conclusions. It is important to continue ongoing reviews of planning and evaluation methods, and to determine preliminary outcomes, in order to capture and assess the available information before it is lost.

This new series of blogs is dedicated to this purpose. Overviews will be provided of the situations facing various types of organizations; some of the administrative strategies that are being attempted (in composite, and as viewed from the outside); factors that are affecting administrative efforts; preliminary identification of issues; and preliminary lessons to be drawn from these efforts. The result is intended to be a “tracking” of implementation of the ACA during these early years.

The discussions to be provided here are based on the methods of organizational analysis described in a recent book by the authors. (FN2) Thus, those readers with an interest in these procedures and their application have a background resource available.

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Footnotes

1. The Patient Protection and Affordable Care Act, P.L. 111-148 (March 23, 2010) as amended by the Health Care and Education Reconciliation Act, P.L. 111-152, (March 30, 2010).

2. Background regarding the methods of organizational analysis applied here may be found in Ferd H. Mitchell and Cheryl C. Mitchell, “Legal Practice Implications of the U.S. National Health Care Plan: Overview and Analysis of the Affordable Care Act, Medicare and Medicaid” (2013 edition), Thomson Reuters/Westlaw (store.westlaw.com).