Affordable fair act: a discussion of the patient protection and affordable care act.

Political slants seem to creep Pi into any discussions of the Patient Protection and Alfordable Clare Act (ACA) Further clouding occurs as pundits, politicians and the media intermix terms, facts and opinions. ACA enthusiasts sight the benefits of providing health coverage to the 17 million uninsured and reining in the insurance companies. The government's participation in a huge sector of the economy and disrupting the free market forces are at the core of ACA opponents' arguments.

As of this writing, more than 40 changes have been made to the law since it was passed. Most notably and recently California passed SB 1446, which delays many small-employer ACA provisions until 2016. Note that most CPA firms and their clients are designated small employers under ACA.

Factors Behind the Changes

Why the seemingly endless parade of changes and delays in implementing the law? To begin with, the law at more than 900 pages is complex and cumbersome, and its content is controversial to say the least. Further, it lays out a framework, in many cases without important details. And rather than a single answer, there are many (actors contributing to the large number of changes on the fly:

* The law contains ambiguities with mam provisions needing the details filled in by government agencies;

* Much of it was developed without industry input on how and what could be practically implemented, creating provisions that did not have apparent or practical implementation methods, technical limitations on how quickly computer systems could be deployed and resources were not available to implement certain provisions.

Examples of the above include the abandoning of the long-term care and free voucher programs, and the delay in the small- business health options program exchange multi-carrier shopping capability.

As various influential groups started figuring out how certain provisions were going to affect diem, politicians and regulators reacted to their voices. The Medicare Advantage patch funding of Medicare Advantage cuts and delays in implementing the employer mandate are two of the more prominent examples among the many special deals for influential groups.

Politicians and regulators did little or nothing to address last year's mass individual policy cancellations primarily because the state and federal exchanges saw any kind of delay or accommodation as a threat to their success.

California SB 1446. signed by Gov. Brown in July, and related federal guidance...