Healthcare Reform Implementation Slower than Expected

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We’ve been covering quite a bit of healthcare-reform news since last Friday, so I suppose it’s only appropriate that we finish up the week in the same manner.

Those who follow politics know that the implementation of any large piece of legislation is rife with complications. With healthcare reform, that observation couldn’t be truer.

According to an article by Alex Wayne at Bloomberg, “The number of Americans projected to gain insurance from the U.S. healthcare law is eroding, by at least 5 million people, as the Obama administration struggles to implement the $1.3 trillion overhaul amid Republican opposition.”

It was hoped that 34 million uninsured people would be covered by 2020. By 2017, the Congressional Budget Office (CBO) expects that number to be 27 million. But now, “expectations are being pulled back as the expansion relies on governors to build a network of insurance marketplaces and expand Medicaid.”

This reliance on the states is backfiring in two ways. First, nearly two dozen Republican governors are resisting health exchanges in their states, and the breadth of opposition to exchanges may increase before it’s all set and done. Second, last summer’s Supreme Court decision allowed the states to “opt out of the Medicaid expansion” and many are choosing to do just that.

The CBO notes, “There is concern ‘about a combination of factors, including the readiness of exchanges to provide a broad array of new insurance options, the ability of state Medicaid programs to absorb new beneficiaries, and people’s responses to the availability of the new coverage.”

Then, there’s the 8 million people who are expected to lose their employer-provided health insurance, up from the 3 million the CBO expected in 2010.

Obviously, going by the CBO report, “‘there’s a problem’ with the implementation of the law,” former CBO director and American Action Forum president Douglas Holtz Eakin told Wayne. “[The CBO knows] that everything they do is subject to a lot of uncertainty. If you see a systematic drift — more uninsured, less employer- sponsored insurance — what they’re saying is, ‘wow, the bad news outweighs the good news.’”

Twenty-six million should be in some kind of exchange plan by 2018, and the government will simply open their own exchanges in states resisting HIEs with Oct. 1 being when people can start to enroll.

And this bumpy ride is to be expected, American Enterprise Institute health economist Joe Antos reminds people. “I think the states have proven that the slowness of getting these things going is not some political reaction that went away when the November election was over. It’s complicated, and like most big reforms – – not just in healthcare, but anything the federal government says is a big reform — the amount of time that was allowed in the law probably wasn’t enough.”

As healthcare executives and leaders, what are your thoughts on the pace the reform rollout is taking? Did you expect this bumpiness? How is your organization strategizing for the difficulties ahead?

-by Pete Fernbaugh

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