PPACA turns two today. Will it reach three?

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The Patient Protection and Affordable Care Act (PPACA, also known as the Affordable Care Act, or ACA) reaches its second anniversary today.  Will it reach three?

There are things already in effect that should be recognized and celebrated.  Congress – under either party’s control — won’t let these fall by the wayside if PPACA somehow magically disappears.

“Helicopter kids” can stay on their parents’ plan until age 26. Lifetime limits were abolished out of the gate: people who had run out of coverage are now finding it flow again.

Regulators are trying hard to keep everyone happy as they shade in PPACA’s broad outlines.  Inevitably everyone is unhappy with some of the choices made, including the lawmakers who wrote the law in the first place.

Myriad details are developing on arcane but real-world issues.  For example, how do you measure eligibility when employee hours vary week to week, or more?  Will states choose the most affordable option for essential health benefits coverage?  How will they squeeze the 10 “buckets” of newly-required coverage into one of the state options – such as the most widely subscribed small business plan in the state?  Will the states be able to open their new health insurance exchanges on time in 2014, and will small employers be able to determine which exchange plan to offer their employees?  The details are mind-numbing in their numbers and complexity.

Retailers, restaurants and other businesses face a fire-hose flood of regulatory details and requirements as they struggle to provide coverage now and planning for coverage (also now) for 2014 and beyond.  The math appears simple after 2014 – the penalty cost will be cheaper than providing coverage – but will a future Congress increase the penalties?  Will employers who continue to offer coverage be better able to attract employees and keep them healthy than those who don’t?

Oral arguments start in the U.S. Supreme Court next week on PPACA’s fate.  The Court could invalidate some, all or none of PPACA…or delay consideration of the health law until someone actually pays a tax penalty under the law.

Questions still abound on PPACA’s anniversary – and, often, each question leads to ten more and different questions.  It is a big, opaque and frequently frustrating law.  Time will tell if these questions – and PPACA itself – will still be here next year.

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