December 3, 2013
In response to crises of performance and confidence, numerous efforts are being made— under pressure—to improve implementation of the Affordable Care Act (ACA).
The Department of Health and Human Services (HHS) continues to seek politically-sustainable arrangements.
In response to this situation, the emphasis by HHS has been on “buying time” to clear up short-term implementation problems, with hope for more “peaceful times” to follow.
Even with the political pressures being exerted at this point, it seems likely that implementation of the ACA will proceed for at least a few more years.
Delays in implementation of the ACA have already spread the phasing-in of activities over a several-year period.
This raises the question: what is the longer-term future of the ACA?
Given the money and attention being thrown at the present operational problems, it appears that some of them—and maybe most—will be fixed over a period of a few years.
These crises may fade away and become mostly of historical interest.
However, deeper issues that are likely to persist relate to how rapidly insurance premiums increase; how well provider networks stabilize; and how purchasers of the new health plans assess their personal experiences after care has been received.
If premiums and costs of care surge, the ACA will be in longer-term difficulty. If provider networks are deemed inadequate, dissatisfaction with care options may begin to require major changes in the ACA.
And, ultimately, personal experiences by the public with use of the ACA “system” will likely determine whether the changes being attempted now are able to achieve long-term survival.
If the ACA settles down with public support, the rate of change may ease and a measure of stability may be achieved.
But if the ACA fails to convert the public through personal experience, over a period of a few years, the result may be growing pressure to “do something else”.
A new period of sequential experimentation may then result. Each “experiment” will likely be built around a new strategy for changing the Health Care System.
It is entirely possible that the result may be a process of “trying something new” for a few years, then “trying something else” for a few more years. The ACA may thus be just “phase 1” of a long-term change process, without a predictable “final destination”.
If this is the situation that evolves, attorneys will not be able to achieve a “new stability” around the ACA, but will have to be constantly relearning about revised options and issues, and redesigning practices as required,
More on these and related ACA topics, with an in-depth discussion of organizational reactions to implementation issues, may be found in a recent book by the authors that describes evolution of the ACA, and in a new Practice Guide by the authors that addresses funding and access issues in health care.