A Hearty "Good Luck" To Two Victims of the Affordable Care Act

While the health reform hand-to-hand combat continues, the Disease Management Care Blog had a chance to see two features of the Affordable Care Act (ACA) up close and personal.

The first was courtesy of the AcademyHealth National Health Policy Conference, where there was a breakout session on how employers will have to cope. It wasn't pretty. The speakers, who were experts on the ACA's wording and the likely supporting regulations, described an emerging horrid thicket of employer and employee tax credits, penalties, fines, benefit design rules, assumptions, subsidies, gaming, audits, reporting requirements and what-if calculations. The DMCB figures that companies that want to buy health insurance for its employees will eventually need to hire a small army of tax and benefit consultants and, despite trying to do the right thing, will still risk being in violation of some rule some where. It's so complicated, the DMCB predicts that it won't be the "money" but the indirect costs, administrative burdens and hassles that will lead to businesses bailing out, paying the fines and pushing their hourly employees into the individual market health exchanges. The DMCB heard that the ACA's architects ultimately wanted employer-sponsored insurance to waste away, and it looks like they'll get their wish. Despite this, however, the message was that the employers liked some features of the ACA and were patriotically planning to comply.

The DMCB wishes our nation's employers good luck.

The second was at a separate conference a few blocks away, where Acting Medicare Administrator Donald Berwick spoke. The good news is that Dr. Berwick's comments amply demonstrated his smarts, credibility and passion. He genuinely believes in the merits of health system change involving electronic records, self-directed care, team-based coordination, dissemination of best practices and paying for value. He supports the ACA "after thinking about it," avoided any gratuitous comments about his boss and brought a roomful of physicians to their feet in a standing ovation. The bad news is that he naively thinks aggressive Federal activism is a good thing for patients and doctors everywhere, that there is broad political support simply because the Angels of Light are on his side and that the huge expanded Medicare bureaucracy is up to the task of leading and executing on centralized health system reform. Dr. Berwick is a good man, but his challenges are practically insurmountable.

The DMCB wishes Administrator Berwick good luck.