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On the Third Hand: Time

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I think that this is about when a flood of stories about whether various parties can or can’t meet various Patient Protection and Affordable Care Act (PPACA) implementation deadlines will start to swirling up the street.

One day, Jan. 1, 2014, seems really far away.

You blink an eye, and blooey, your cellar is full of lawsuits about messed up computer systems and the boiler stops working.

Some readers have noticed that, once in awhile, my articles are a bit disjointed. Perhaps even hastily proofread. As in, a typo every other paragraph. That’s partly because even covering PPACA developments enough that you have some idea what mammoth new documents are in the Federal Register takes a lot of rushing around.

If I have to rush around so much I barely have time to read the articles about PPACA that I’ve written, you’ve got to wonder how much hair the regulators who are trying to implement the statutes are tearing out. No matter how nice or how nasty, or how capitalistic or how socialistic those regulators are, at some point they must run out of hair and end up digging into scalp.

One obvious sign that the flood of stories about looming and missed deadlines is coming is the lead I buried in an article that ran Jan. 25, Feds: Some “indemnity plans” come under PPACA.

The grim truth is that, on busy news days, I’m so rushed that, for production reasons, I sometimes have to give my editors a headline and lead before I’ve really finished work on a story. On Jan. 25, I looked at some new PPACA guidance from the Employee Benefits Security Administration and quickly found something interesting — even, in a grim, wonky, regulatory way, funny — about how EBSA is thinking about what is and is not an indemnity health insurance policy that’s exempt from PPACA.

Then, after I came up with the nice headline and lead about indemnity insurance, I found this bit of dry wit:

The Department of Labor has concluded that the [PPACA exchange existence] notice requirement… will not take effect on March 1, 2013 for several reasons. First, this notice should be coordinated with HHS’s educational efforts and Internal Revenue Service (IRS) guidance on minimum value. Second, we are committed to a smooth implementation process including providing employers with sufficient time to comply and selecting an applicability date that ensures that employees receive the information at a meaningful time. The Department of Labor expects that the timing for distribution of notices will be the late summer or fall of 2013, which will coordinate with the open enrollment period for Exchanges.

In other words: The EBSA guidance writers were saying, “No way is anyone going to have exchange notice regulations ready by March. No. Way. Deal with it, bozos.”

More on this topic

Milliman actuarial consultants have come up with the PPACA deadline panic season equivalent of an NCAA March Madness bracket by posting a nice PPACA implementation schedule timeline on the Web. 

On the one hand: The Milliman timeline is really helpful.

On the other hand: Everything takes longer and costs more. If that’s true for re-doing your kitchen, it’s got to be doubly true for reorganizing the U.S. health care system. Even if we had just adopted the AHIP reform plan — or even the Council for Affordable Health Insurance reform plan — as written, we’d still be going through a fair amount of deadline-driven consternation.

On the third hand: What’s amazing is how the day of health insurance reckoning still hasn’t come, even after all of those years. It seems to be coming soon, but it seemed to be coming soon in 1993, in 1996, in the late 1990s, and again in the early 2000s. It never quite came.

Maybe these upcoming days of PPACA reckoning will be more like days of mild aggravation and, somehow, in spite all of the excitement and all of the fear, what will really happen is that we just keep muddling through.  

On the fourth hand: That’s pretty much what I said about Sandy, and, look what Sandy did. So, you never know. Maybe this cataclysm will live up to its billing.

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