PPACA: “It’s in there!”

September 9, 2017

If you’re my age you may recall the Prego spaghetti sauce ads from the 1980s. “It’s in there,” replied the convenience-seeking housewife whenever the husband questioned whether the sauce had a particular ingredient. The same thing is true of the Patient Protection and Affordable Care Act. It contains everything you might expect, like the individual mandate, subsidies to buy health insurance and medical loss ratio rules for insurers. But it also contains a good number of relatively obscure, yet potentially significant items.

California Healthline (Overlooked but Not Forgotten: Three Lesser-Known Reforms) highlights some of these items on PPACA’s first birthday.

  • $15 billion over 10 years for a Prevention and Public Health Fund for wellness initiatives
  • A 6500 person Public Health Service Ready Reserve Corps for emergency response to public health crises and national emergencies
  • Accountable Care Organizations that could integrate physical and mental health care to address the large number of people with both kinds of health problems
  • A pathway for the approval of generic (or “similar”) versions of biotech drugs. The wording in this section was pretty vague, so there is active fighting underway on key definitions that affect the timing of new drug introduction

It will be interesting to see whether the PPACA fight settles down at all over the next year. My best guess is more of the same: a dedicated group working on the details of implementation, and an even more fervent bunch trying to reverse the law or undermine it. Perhaps as the Republican primary campaign gets underway we’ll start to hear someone articulate alternatives to PPACA that are more thoughtful than the knee-jerk rejections of “ObamaCare” that pass for policy these days. If a Republican is willing to tackle Medicare costs in a serious way I’ll  be eager to hear about it.

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