Health Reform: The Early Days

July 12, 2010

Early reviews are in and they are favorable! Public opinion polls show support for the Affordable Care Act (ACA) creeping up to 48 percent. All of that is good news, and a well-deserved commentary on health reform: States and the U.S. Department of Health and Human Services have been moving quickly to put in place the most immediate requirements of the law, and communities, providers, and others are stepping up to participate in health reform opportunities (e.g., funding for more primary care training slots through the Prevention and Public Health Fund). In addition, states have announced the beginnings of temporary high risk pools, and the federal government has debuted a new website – – to help consumers in every state navigate their health care options.

These achievements are quite impressive. The work produced to date has been of good quality and has moved quickly in accordance with the commitments made in the ACA. And all of this has happened without a Medicare/Medicaid director in place – which will now change given President Obama’s recess appointment of Don Berwick.

These early steps are critical: their importance cannot be over-estimated. Indeed, if one looks closely at the dialog around health reform, it seems clear that the tone and expectations around the ACA have changed in a significant way: it’s beginning to feel like the ACA (in its broadest principles at least) will survive.

While the lawsuits challenging the ACA continue (testimony was given in the first lawsuit in Virginia on July 1, and hearings will begin in Michigan and California later this month) and are likely to end up in the Supreme Court, the work of implementation goes on. The activity around the implementation of health reform is building a sense of permanency around the ACA. Even states who are suing to stop the law are simultaneously moving forward to take advantage of many of its provisions.

Advocates bemoan the fact that the major coverage elements don’t go into effect until 2014, and many feel without those elements, most people won’t really see how health reform benefits them. But as health reform is unfolding, and with everything that is happening before 2014, it is now apparent that people all around the country will feel the effects of health reform long before the major coverage elements go into effect. And even if court challenges are successful, unwinding health reform will be difficult at best. Moving a bureaucracy to implement new things is tremendously difficult (especially when dealing with one sixth of the economy): reversing directions is even harder.

Those who want to see this law succeed might now see real hope for at least key elements of the law to survive. And while the individual mandate is the piece of the law with the least public support and the greatest risk in the courts, there is much more in health reform to improve the system beyond the individual mandate.

Now, if just a little more effort could be put into helping the public at the grass roots level understand just what health reform really is and how it benefits them, maybe even the individual mandate will survive…