ACA Slowdowns Affect Public Administrators

By Ferd H. Mitchell and Cheryl C. Mitchell

Several major changes in implementation of the Affordable Care Act (ACA) have been introduced to deal with the operational and political problems facing program administrators. All of these changes provide significant insights into various strategies that may be incorporated into the field of public administration for a range of program activities.

Postponement of the large-employer mandate to 2015 has allowed employers to continue to offer health plans that do not meet the requirements of Qualified Health Plans (QHPs). Political guarantees to allow individuals to keep prior plans for 2014 may be selectively effective where approved by insurance commissioners and accepted by insurance companies. And some people with cancelled individual policies are now being allowed to obtain hardship exemptions for 2014, allowing the shift to QHPs to be delayed.

Further, because of sign-up problems, high-risk pools have also been continued into 2014 to prevent these individuals from losing all coverage.

Some insurance companies continue to offer mini-med plans for individuals not purchasing QHPs. Individuals purchasing such plans may have to pay a penalty.

The combined effect is to reduce QHP coverage in 2014 and to slow down the implementation process. There are several lessons that may be learned from the adaptive changes to ACA regulations.

When political pressures mount, it may be wise to look for accommodation and not try to “hold the line”.However, a price will be paid for such changes.

The result of the adjustments noted above will generally be to slow down the transition to an ACA-based Health Care System. Some of the linkages among organizations, which are intended to be strengthened, may remain less changed than wished.

The slowdown will have positive features, including more time for individuals and organizations to adjust to changes in the ACA.

But, at the same time, the slowdown may have negative aspects, as implementation momentum is lost and ACA “drift” is allowed to develop.

Thus, administrators face tradeoffs when they accommodate outside pressures during program implementation. Positive and negative features must both be examined carefully.

It will be interesting to track how these—and other—changes in the ACA play out during 2014 and future years.


This is installment #17 in the “Affordable Care Act and Public Administration” series.

Previous installments of this series have considered impact of the ACA on the field of public administration from a variety of perspectives. Refer to the archived postings for this blog to review all of these installments and obtain an overview of the combined commentary. (Or search for “health care”, “ACA” or “Mitchell” in the search box somewhat below the top of the home page).

More on these and related ACA topics, including coverage of how organizational reactions affect implementation efforts, may be found in a recent book by the authors that describes evolution of the ACA, and in a new Practice Guide by the authors that addresses funding and access issues in health care.


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