As we approach the 2012 presidential election, health care reform and the Patient Protection and Affordable Care Act (PPACA) continue to play a role in the national debate. With the help of Jim O'Connell, Ceridian's executive consultant in Washington, D.C., we explore how the election outcome could affect PPACA's implementation. 

2 possible health care reform scenarios ... and one sure thing

jim-oconnell.jpgAs we approach the 2012 presidential election, health care reform and the Patient Protection and Affordable Care Act (PPACA) continue to play a role in the national debate. With the help of Jim O'Connell, Ceridian's executive consultant in Washington, D.C., we explore how the election outcome could affect PPACA's implementation.

"No matter who gets elected, the key to health care reform is the state health insurance exchange program," O'Connell said. "In order for the employer mandate and the individual mandate to work, these exchanges would have to be in place for 2014 open enrollment — just one year from now in October 2013."
 
"One can say what one wants about the Patient Protection and Affordable Care Act of 2010, but one thing is certain: It has made health care reform a permanent part of the legislative landscape."


- Jim O'Connell

Scenario 1: Status Quo

If President Obama is re-elected, implementation of health care reform would continue as planned. In this scenario, the Department of Health and Human Services (HHS) might become more aggressive in enforcing compliance with PPACA and pushing the states to create health insurance exchanges, O'Connell said. 

But according to the Washington Post, so far only 13 states have taken steps to set up an exchange. If states decide not to create exchanges, the law authorizes the federal government to step in and operate an exchange for them. HHS continues to support states that wish to plan and establish exchanges, citing flexibility as the primary advantage to states running their own exchanges. 

"In the Status Quo scenario, many variables still exist. Most of the states are not ready, and would either have to scramble to comply with the exchange requirement, or simply give up control and let the federal government take over," O'Connell said. In any event, a second Obama administration is likely to press for full implementation of the law, including the employer and individual mandates.

Scenario 2: New President

While many Republicans have vowed to repeal PPACA if given the chance, O'Connell does not believe that there would be a full repeal of the law if Mitt Romney were elected. "The 'insurance reforms' already in place — such as age-26 coverage for dependents and the ban on pre-existing condition exclusions for children — are too popular to abandon altogether," he said. 

O'Connell said that in the New President scenario, we could expect HHS delays in implementing controversial provisions of PPACA. Implementation of state health insurance exchanges, the individual mandate and the employer mandate could be placed on hold administratively while Congress attempts to reshape the law.

The one sure thing

"One can say what one wants about the Patient Protection and Affordable Care Act of 2010," O'Connell said. "But one thing is certain: It has made health care reform a permanent part of the legislative landscape."

Similar to Medicare, Medicaid and ERISA, O'Connell predicts that PPACA will continue to be amended for years to come regardless of the outcome of this year's elections. Some unpopular provisions already have been stricken from PPACA, such as a small business reporting requirement that would have created a costly administrative burden. "There are a million little details still to be worked out. This will be a bipartisan process, and we can expect it to go on forever," O'Connell said. 

Regardless of who occupies the White House come 2013, O'Connell said that employers with 50 or more full-time employees should remain focused on compliance: "Consult your legal counsel for help in interpreting federal guidance as it is released, and stay up-to-date on compliance issues through organizations such as SHRM." And of course, CeridianVoice will continue to provide updates on this topic.

For more information:

  • Read Jim O'Connell's HR Legislation blog
  • Visit the DOL's health care reform resource page for employers