The ACA Goes Public

Preparing for the Next Six Months

By Cheryl and Ferd Mitchell

For the past 3 years, planning for the Affordable Care Act (ACA) has been largely behind the scenes. But major change will be taking

place over the next 6 months.

The new Health Exchanges have to be up and running by October 1, 2013, with Qualified Health Plans (QHPs) ready to be sold to the public. These QHP insurance policies are to become effective on January 1, 2014. All related activities must now “go public”.

At the same time, implementation efforts for expanded state Medicaid programs (to be in effect only in those states that have chosen to proceed) also have to go public, to provide expanded eligibility on January 1.

This shift from hidden agency operations to partial viewing is going to provide administrators from all organizations with new insights as to the efforts that have been under way.

Check out our first article in this series, Putting the Affordable Care Act Into Action, which provides a brief introduction as to how implementation efforts by these agencies have looked from the outside. It will soon be possible to see, at least partially, what has been going on inside.

Our second installation, Federal Agencies Struggle to Implement ACA, provided thoughts regarding the issues that federal agencies have faced up to now. More detail will soon be revealed as to how budgeting, technology development, and outreach have been approached by them.

What will this shift to going more public mean for the ACA over the next 6 months?

Federal agencies that have been focused on planning and preparation must now prepare to “make it happen” — a new experience in some areas. Based on hints of problems to date, this may not be an easy shift. It will soon be possible to compare “what was done to get ready”, with “how implementation is going.”

healthcareState agencies have often been waiting and watching for a shift that would increase their relevance and duties. As implementation moves ahead, they must support all executive and legislative offices, act as buffers with federal agencies, help back up the Exchanges, supervise expanded Medicaid programs (where applicable) or otherwise deal with state issues over less money coming from Medicaid, and be on the front lines in responding to the public regarding ACA-related activities.

Local agencies and nonprofit groups are stepping up to a national “navigator” program, and have to learn about their new duties. They will need to be effective at identifying, educating, and supporting individuals who need insurance coverage, so these individuals can find their ways to the new Health Exchanges and purchase insurance.

Local provider groups will also have to cope with more patients; the get-ready preparation by these providers will soon be on display.

It is yet to be determined how well these organizations at the federal, state, and local level will be able to “play together” and stride toward a common objective.

The implementation of the ACA across the U.S. is going to have some common threads, but also be extremely variable. Some states will have state Exchanges, some federal Exchanges, and some partnership Exchanges. Insurance companies are expected to participate to varying degrees in different states.

The expanded Medicaid programs will be implemented in only some states. Other states are likely to struggle to deal with less Medicaid funding for low-income individuals and families.

The navigator programs to bring the public to the Exchanges will be keyed to local organizations and conditions. The local health  care systems are often very different from one community to another. And the needs and attitudes of the public will vary among communities.

Therefore, implementation of the ACA is going to be far from uniform across the country. Experiences will not be the same everywhere. Local insights will be critical. But it will also be necessary to try and interpret all of these local experiences in a way that leads to lessons and insights for the “big picture” associated with the ACA. As the implementation efforts go public, evaluation of the ACA will be a multi-layered task.


This is installment #3 of a continuing series of blogs dedicated to the tracking of implementation efforts for the ACA and the administrative insights that may be gained. To read article #1, click here. To read article #2, click here.

4 thoughts on “The ACA Goes Public

  1. Hi Warren,

    ASPA certainly welcomes the cross-posting. Please feel free to share the links to these posts on the ASPA blog.

    Melissa Williams
    ASPA Communications Director


  2. I would like to feature this series on ASPA’s Good Governance Worldwide Web site ( by adding a hyperlink to all 3 blog posts and soliciting case illustrations of implementation models from arond the country. Would you like to partner with ASPA’s Section for Public Management Practice on this venture? Warren Master, Managing Editor, Good Governance Worldwide and Chairperson, SPMP


Tell Us What You Think

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s