On the 13th of March, my wife and I celebrated our 6th wedding anniversary. We found out that the 6th year is the iron anniversary. We commemorated this by going out to dinner and seeing the film Black Swan. I’m still trying to figure out what a chicken sandwich and the latest celluloid self-abuse fest from Darren Aronofsky have to do with iron, but nothing made of this particular element struck our fancy.
The first anniversary is celebrated with paper, and do I ever have a chunk of paper with which to celebrate the latest one.
This past Wednesday marked the first anniversary of the passage of the Patient Protection and Affordable Care Act. The 2,409-page document, despite a few current legal decisions to the contrary, remains the blueprint for expanding health care coverage to as many citizens of the United States as possible by 2014.
The last year has been an odd journey for this law. In the past year, we’ve seen the House of Representatives switch parties, with the new party putting forth as their first piece of legislation a full repeal of the Act. We’ve seen two judicial votes against and three votes for implementing the act as it is currently written. We’ve seen Aetna and Cigna, two of the richest corporations in America, look the government in the face and tell them that they couldn’t afford to provide their employees with the minimum coverage mandated in the act, and the government believed them and granted a waiver.
With all of this in it’s first year, the biggest threat to the implementation of the act as written is currently one that rumbles under the surface. The creation of state-run exchanges and the expansion of Medicaid coverage mandated in the Act is encountering the roadblock of America’s lingering economic quagmire. An almost genetic unwillingness to raise revenue from the upper end of the existing tax base is leading many state legislatures, including my own, to cut every service for everyone unfortunate enough not to be able to afford a seat at the lobbying table. One of the prime targets across the country has been Medicaid spending. State budgets are a mess, and excitement about expanding Medicaid, especially for bigger states such as Texas and California, is non-existent.
A few weeks ago, President Obama attempted to bridge this divide by proposing to change the time frames for state innovation waivers from the current 2017 to 2014. It’s a calculated gamble from an administration seemingly saying “if you can do it cheaper and provide the same level of coverage, while not increasing the federal deficit, be my guest”. Unfortunately, the audience for this message consists of the same states who are suing to negate the Act prior to that date. The states of Vermont and Massachusetts, who were uniquely positioned from standpoints of politics and existing policy prior to PPACA, would appear to already qualify for the waiver.
One part of PPACA that is going well is anti-fraud activity. $4 billion was collected in fiscal year 2010. We have yet to hear the final numbers for the Medicare RAC program for 2010, but all indications are that the number will provide enough encouragement to expand the program to Medicare Parts C & D some time in 2012. The Medicaid RAC program final rule is due later this year.
For its paper anniversary, PPACA is creating and giving more than it’s receiving. A majority of the goals of the legislation are still three years away, but the journey of health care reform continues.