Affordable Care Act: five years have gone by so quickly.

• Author: Lang, Ron
• Position: Health care

The Patient Protection and Affordable Care Act (ACA) was passed more than five years ago. Never has a piece of federal legislation been in the controversy spotlight for this length of time.

Typically, new federal and state laws require some tweaking before, during or after they are implemented. Fix-it bills can clarify the original intentions of lawmakers, correct mistakes and make the legislation practical to implement. In the ACA's circumstance, because of the high level of animosity surrounding the law's fundamentals, significant fixes are not politically feasible.

Congress addressed about a dozen, below-the-radar fixes that have not been newsworthy--repealing the Free Choice Voucher Program and exemptions for TRICARE health plans, for example.

This has left the majority of the heavy lifting fix-it work with the ACA's three primary regulatory agencies: the IRS, the Department of Health and Human Services and the Department of Labor. Each of these agencies issued regulations, determinations and fixes. And, on a number of major cross agency topics, have issued joint releases to provide singular direction through ambiguous and conflicting provisions.

More than 30 safe harbors, definitions and delays by administrative action have been issued over the last five years, which creates additional controversy and litigation.

The path the ACA took through the legislative process did not provide it the typical amendment process, so it contained provisions that are difficult to implement and opened it up for legal challenges. Without a fix-it bill, it will be up to the courts and, in many instances, the U.S. Supreme Court, to determine if agency actions are consistent with the ACA.

This term, the court will decide if the IRS was within its authority to grant premium subsidies to individuals obtaining policies in states utilizing the federal exchange. Legal scholars are expecting the court to allow the subsidies to continue, despite the feelings of ACA opponents. But nothing is certain. Congress could act to clarify the provision to include or exclude the federal exchange states and take it out of the courts hands, but they are paralyzed to even attempt to do so.

Conventional wisdom holds that while the Supreme Court may strike down a provision or two, it will not repeal the ACA. So if we could wave a magic political wand of bipartisan cooperation, what could be fixed in the act to make it more practical?

A goal of the ACA was to provide access to...