Healthcare (February 2013)

We are on the edge of a dangerous precipice. 

Like it or not, the Affordable Care Act is the law of the land. Both houses of Congress passed it. The Supreme Court upheld it. And the 2012 election confirmed it. The question is not whether the ACA will be implemented, but how well.

Across the country, states and individuals are dealing with the new regulations and costs being imposed by the Patient Protection and Affordable Care Act (PPACA), more commonly known as ObamaCare. Among the most burdensome regulations states face is making the decision of whether or not to set up state-based health insurance exchanges. 

The Obama administration’s plan to implement insurance exchanges in time for Jan. 1, 2014, enrollment has met substantial state government opposition, raised more questions than answers and flashed warning signs of trouble ahead. A clear majority of states — 34 — still are not fully on board with running their own healthcare exchanges to comply with the dictates of the Affordable Care Act (ACA). Most of those states — as many as 26 — would rather leave the daunting implementation process entirely in the hands of federal officials. Just last week, Utah finally gave up on getting authorization for its proposed state-based exchange for individuals.

When the Affordable Care Act was debated in Congress, the House of Representatives wanted one federal exchange and as much federal control of state insurance markets as possible. The Senate wanted state insurance exchanges and state flexibility to tailor market rules to local market conditions. 

If we are to significantly improve the quality, safety and cost-effectiveness of healthcare in our nation, we must employ the power of health information technology (IT).