To follow up on my last blog post, I wanted to wrap up the summary of our latest webinar. My presentation made the point that with republicans now in the majority in the U.S. House of Representatives, there is a possibility that healthcare reform, opposed by all republican lawmakers in 2010, will itself be reformed.

I began by discussing the single biggest healthcare reform challenge now facing employers and insurance carriers—total uncertainty. No one really knows what the PPACA will mean for employer-sponsored health benefits.

To be sure, there are many aspects of healthcare reform about which employers are uncertain: they don’t know whether the PPACA will bend the cost curve down, as promised, or up; similarly, they have no idea whether they will be able to comply with the many mandates included in the new law. They also worry about the law’s impending tax increases, including the 40% excise tax on high-value health plans slated for 2018. Read more.

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Healthcare Reform Webinar: Uncertainty the Only Certainty (part 2)

Tue Mar 1, 2011

To follow up on my last blog post, I wanted to wrap up the summary of our latest webinar. My presentation made the point that with republicans now in the majority in the U.S. House of Representatives, there is a possibility that healthcare reform, opposed by all republican lawmakers in 2010, will itself be reformed.

I began by discussing the single biggest healthcare reform challenge now facing employers and insurance carriers—total uncertainty. No one really knows what the PPACA will mean for employer-sponsored health benefits.

To be sure, there are many aspects of healthcare reform about which employers are uncertain: they don’t know whether the PPACA will bend the cost curve down, as promised, or up; similarly, they have no idea whether they will be able to comply with the many mandates included in the new law. They also worry about the law’s impending tax increases, including the 40% excise tax on high-value health plans slated for 2018.

Employers and carriers are also uncertain about the waves of new government regulations sure to cascade for years to come, as federal agencies implement the 2,700 page law. And the recent federal court decisions in Virginia and Florida invalidating the individual mandate did nothing to relieve employer uncertainty—indeed the judges have only compounded it.

I then addressed the question, will healthcare reform be reformed? Employers, workers, insurance carriers, states, brokers, indeed everyone with an interest in healthcare reform are watching developments on Capitol Hill. Republicans, now in control of the House of Representatives, have pledged to roll back controversial provisions in the new law, which some surveys indicate almost half of Americans oppose.

First on the list of action items is legislation to “Repeal & Replace” the entire law. I noted that the House voted January 19 to do just that, by a vote of 245-189. The U.S. Senate, still controlled by democrats, is expected to block that legislation on procedural grounds.

But PPACA opponents have fallbacks, including “de-funding” agencies like HHS and IRS charged with enforcing the new law. For example, the House recently passed a bill, not expected to be approved by the Senate, that would prohibit IRS from hiring additional agents whose jobs would be to enforce PPACA tax provisions. Delay of effective dates might be another strategy to derail the new law.

I also pointed out that republicans can be expected to target what they consider particularly objectionable parts of the law, including the individual mandate, the employer “play or pay” mandate and the so-called CLASS Act government long-term care insurance program.

We then shifted gears to what’s happening at the state level. I told attendees that twenty-one states have written HHS secretary Kathleen Sebelius requesting waivers from provisions of the PPACA relating to the state exchanges. In a February 7 Wall Street Journal op-ed, Indiana governor Mitch Daniels listed a number of conditions that he says must be met in order for these states to agree to implement the state exchanges specified in the PPACA. Without getting into the details, I suggested that the op-ed and letter demonstrate that many states intend to decide exactly how the PPACA gets implemented within their jurisdictions.

Incidentally, President Obama told governors meeting in Washington DC on Monday that he was open to legislation that would give states greater flexibility in implementing the healthcare reform law as long as the states met the measure’s major objectives.

My overall conclusion is that the President’s signature healthcare reform law, the Patient Protection & Affordable Care Act, will surely be changed—the only questions being how and when.

The main reason is that lasting national policy reform, like Social Security, the Civil Rights Act, Medicare and the Family & Medical Leave Act, requires bipartisan support. Fundamental social policy reform cannot be subject to the political winds—to come and go and then come and go again each time White House party affiliation changes.

I concluded my presentation with the thought that March 23, 2010, the date President Obama signed the PPACA into law, was the beginning of healthcare reform, not the end.