November 26, 2014
The Affordable Care Act (ACA) is probing the limits of adaptability for people and technology when faced with complex, interactive programs.
Program implementation is at a critical stage.
By and large, people are comfortable with a certain level of change, but become resistant to being pushed to move faster.
Technology may be relatively easy to harness for more confined tasks, or when adequate time is allowed for more difficult tasks, but often does not function well when high levels of complex technology are combined with urgent schedules.
As Year 2 enrollment starts up, evolution of the ACA is probing these limits.
The Department of Health and Human Services (HHS) is pushing to bring harder-to-reach individuals into the Exchange enrollment efforts.
But many of these individuals have to be taught about the ACA (and even about health insurance) from scratch, and do not want to be pushed to participate.
Advisors and navigators are becoming stressed as they attempt to deal with this situation.
Computer systems continue to be pushed to the “ragged edge” of the feasible, with steadily-increasing complexity.
System designers are also being stressed as they attempt to add on new enrollment and re-enrollment features, try to fix and update Exchange features from last year, and try to fix processing and interface features that have never been fully operational.
The ACA continues to be widely unpopular among the public.
Much of the negativity comes from the rapid change being sought in a short time.
The end result is that advising clients about the ACA is difficult. The law itself is a highly complex mix of statutes, regulations and procedures, and is time-consuming for attorneys to explore.
In addition, changes in individual and organizational perceptions and activities provide a constantly-moving backdrop for the program.
Legal practices have to consider the law as a foundation, with individual and organizational reactions shaping how implementation actually proceeds.
In this environment, it is challenging to explain the law; explain available options; and problem-solve for clients.
Media reports are often of limited assistance, since the focus is usually on micro-reports, which fail to assist with the “big picture”.
A process of establishing a general viewpoint, and then assessing how individuals fit in, can be a useful practice strategy. A dual approach—of combined broad perspective and ongoing detail—can enhance attorney effectiveness at this critical time for the program.
More information about implementation of the Affordable Care Act and associated legal practice issues may be found in recent books on the ACA and on the health care system, other postings to this blog, and on the ACA Blog, also written by the author of this series.