The ultimate "we told you so!".

• Author: Tanner, Michael
• Position: Patient Protection and Affordable Care Act - Public Policy

IN MARCH 2010, as the debate over passage of the Patient Protection and Affordable Care Act was winding down, House Speaker Nancy Pelosi (D.-Calif.) famously said, "We have to pass the bill so that you can find out what is in it." It now has been nearly four years since the legislation passed, and most of its key components have taken effect, giving us a fair opportunity to "find out what is in it."

The law deliberately was designed so that many of the provisions apt to be most popular would take effect first. Thus, provisions such as allowing children to stay on their parents' policy until age 26 started on Sept. 23, 2010. However, the law's key provisions --the individual mandate, prohibitions on medical underwriting of preexisting conditions, subsidies, Medicaid expansion, and the operation of exchanges in all 50 states and the District of Columbia--started on Jan. 1, 2014. (Another important provision, the employer mandate, also was fl scheduled to begin on Jan. 1, but the Obama Administration--unconstitutionally, we might add--postponed the effective date until Jan. 1, 2015, and then instituted another postponement for businesses with 50-100 fulltime employees until 2016; both edicts were issued with an eye on November's congressional elections.)

News coverage was dominated by the "train wreck" that has been the rollout of the exchanges and the computer problems that accompanied it. However, most of those issues have been corrected and, as Pres. Barack Obama repeatedly has reminded us, the health care law is "not just a website. It's much more."

In many ways, the system's computer difficulties actually obscured other much more significant problems with the law. Those go much deeper than a failed website. They could result in millions of Americans being forced to change insurance plans, even if satisfied with their current policy, and in millions more being unable to keep seeing their current doctor (at least not without significant additional expense). In addition, while there will be winners and losers when it comes to the cost of insurance, millions of Americans will find themselves paying higher premiums or facing higher out-of-pocket expenses--or both. The law also is likely to slow economic growth and kill jobs.

Some of these consequences already ready can be seen. Others easily are predicted. Yet, some important questions remain. We do not yet know whether the program's adverse selection problems will be severe enough to cause...