Healthcare Reform At One Year
BY LAUREN UZDIENSKI, MARCH 22, 2011
This week last year the monumental Affordable Care Act was signed into law, and even as the legislation's more moderate reforms go into effect, controversy still swirls over the law's constitutionality and budget impact.
As you'll recall, the Affordable Care Act was only passed after months of debate and myriad iterations, including modifications to the public option, one of the cornerstones of President Obama's initial proposal. The overhaul would insure 32 million new patients and was estimated to cost $940 billion over the next decade, though later reports suggested that number could increase and exceed the $1 trillion mark on "discretionary" spending. The Congressional Budget Office determined that the legislation would reduce the deficit by $143 billion over the first ten years.
A number of new regulations from the package have already gone into effect, like certain insurance reforms. Among them, insurers can't deny coverage based on pre-existing conditions, adult children can stay on a parent's insurance until 26 and there are no lifetime limits on a patient's benefits. The more contentious elements of the package don't go into effect until 2014, like the individual mandate that requires all Americans to have insurance and, in the device space, the 2.3% excise tax on all devices sold.
Almost immediately after the reform act was passed, states began filing lawsuits against it, alleging that some requirements were unconstitutional. So far, judges in Florida and Virginia have agreed, while two other courts ruled in favor of the law. Now the question of constitutionality is expected to be decided by the Supreme Court. In the meantime, smaller challenges persist, including a bill from Minnesota Rep Erik Paulsen to eliminate the device tax. The White House has also compromised somewhat on the argument that the Affordable Care Act impinges on states' rights. The Wyden-Brown amendment recently offered an alternative to expansive federal oversight of the changes: if a state can produce an insurance program that covers as many people as cheaply as the ACA, they can implement their own program without giving up federal funding.
Some of the biggest questions still remain about the cost of implementing these programs and the economic impact of the overhaul. The Washington Post reported last month that the Congressional Budget Office estimated that healthcare reform could cost the U.S. 800,000 jobs by 2021, creating a huge gulf between the budget and Democrats' estimates. Former Speaker Nancy Pelosi has said that the legislation would create four million jobs, a projection that apparently comes from the assumption that cheaper healthcare will allow companies to hire more workers. Companies in the medical technology sector have warned that the device tax, which would contribute about $20 billion to the cost of implementing healthcare reform, may cost jobs and suppress innovation.
