Today marks the one-year anniversary since passage of the Patient Protection and Affordable Care Act of 2010 (PPACA; later shortened to the Affordable Care Act or ACA). However, I’m not sure that retailers are in all that much of a mood to celebrate this occasion.
We mourn the opportunity this law missed to focus on what really matters in health care: restraining the cost of medical care. Entitlements (e.g. Medicare, Medicaid & Social Security) — already driving the national debt and swamping both federal and state governments – received limited attention (e.g. accountable care organizations) or were expanded (Medicaid), to the states’ collective great peril. The employer mandate penalties (e.g. the employer “responsibility” provisions) are structured in a way to encourage employers (larger than 50) to dismantle the employer-based health care system beginning in 2014. We do not apologize for seeking to overturn this law or to delay its implementation or to seek to make major changes to it.
But, retailers are realists above all else. Health care reform is still the law of the land today. So, we are working hard to make the best of this massive and unnecessarily complex law. But, no wonder it is still unpopular – people struggle to understand exactly what is coming and when. NRF spends a lot of time just explaining the basics.
We give the Obama Administration credit for generally trying to make the best of a bad law. Republicans are right to say that a better law would not have required thousands of waivers. But, the Administration and its allies are also right to say that waivers are a necessary part of the transition to 2014.
For our part, we appreciate the steps taken to safeguard existing limited coverage from application of the restrictions on annual benefit limits and medical loss ratio (MLR) standards. Keeping the coverage one has now also includes keeping coverage that might not get the Good Housekeeping Seal of Coverage approval – until more affordable and comprehensive alternatives are available. These waivers – and the state waivers from MLR – make good, pragmatic sense.
But, even some erstwhile supporters – like Howard Schultz, Starbucks CEO – are having second thoughts on their past support for the law. Momentum for repeal or substantial modification is growing. By this time next year, perhaps the U.S. Supreme Court may have considered the constitutionality of key sections – especially the individual mandate for coverage.
So, give a nod to PPACA/ACA on its first birthday. Will it get a second birthday or more? Only time and hard work will tell….