Just like a typical three-year-old, the Affordable Care Act (a.k.a. Obamacare) is undergoing a period of rapid growth and development. For those who still cling to the nostalgic notion that once legislation is passed and signed the lawmaking stops, think again. The single largest piece of regulation ever passed has grown 10-fold in its short life, to more than 20,000 pages standing seven feet tall, since the President signed it into law on March 23, 2010.
Some of the mandates, such as covering preexisting conditions in kids under 19 years old, took effect immediately, while many others continue to be phased in, with the most pronounced changes set to come at the start of 2014. As that day fast approaches, the flow of anecdotes and concerns seems to be mounting.
Just today, the Wall Street journal is reporting that insurers are forecasting premium increases of up to 50% for some families, while Investor's Business Daily compiled a list of 10 Disturbing Facts About Obamacare, most of which have to do with unforeseen costs, while all of them point to the simple fact that this monstrous law is still one great big pile of unknowns.
"We're nowhere near the implementation of the Affordable Care Act," says Paul Keckley, Executive Director of the Deloitte Center for Health Solutions, in the attached video. Putting aside price and the many other practical questions that surround the law for a moment, Keckley says the creation of State-run insurance exchanges and the expansion of medicaid are the two major logistical obstacles that still must be cleared. "States have to make a calculated bet as to whether, in the long-term, expansion of medicaid is a good thing or a bad thing."
As for the mass market impacts and the impact Obamacare will have on businesses large and small, Keckley says "there's a suspicion on the part of employers that the law doesn't really bend the cost curve and it doesn't really fundamentally restructure the system."
With just nine months until full implementation, a lot is still unknown. Even nationally renowned experts such as Keckley concede there's a high degree of mystery that shrouds this ever-growing body of law. For example, he says the jury is still out over whether paying doctors for outcomes (results) instead of volume (procedures), reduces costs.
"We consider the law to be a work in progress," Keckley says. "We know that it will increase access (by 29-32 million people), but we don't know if it will reduce costs simultaneously. That's the big bet."