One econ major. Three (or more) opinions.

Maybe I helped create the focus on punctuality of implementation of the Patient Protection and Affordable Care Act (PPACA).

These past couple of weeks, it’s seemed as if actual and fake PPACA delay stories have been coming out more often.

Idaho, for example, really did postpone its efforts to set up a state-based exchange system for a year, and Oregon really put off the launch of its exchange website for a few weeks, until late October.

The U.S. Department of Health and Human Services (HHS) did not really suddenly, furtively increase out-of-pocket maximums for health plan enrollees this week, even though media reports made it sound as if it had.

Figuring out how to write about, for example, a 300-page regulation rough draft is complicated.

It’s much, much easier to search for references to terms such as “transition relief” and “postpone” and write about delays in implementation than to figure out what the stuff in the other 298 pages of the regulation could do.

To the extent that PPACA is a gladiatorial contest between the Obama administration and the Republicans, noticing implementation delays is a bit like detecting beads of sweat on a gladiator’s brow. Maybe it’s a sign the gladiator is weakening.

To the extent that people in the health insurance community are trying to look at the PPACA health insurance market rules and exchange system with some level of professional detachment, it seems to me that the goal should be, of course, to kill off what you think you can and should kill off, but to see any parts that survive implemented as quickly and as well as possible.

On the one hand, if you think PPACA is a mess, how could you really object if PPACA (or part of PPACA) came to life quickly and turned out to work great? Learning to sell more disability insurance and critical illness insurance, or more fee-paid patient advocacy services, might be challenging, but not as challenging as being a sick person without access to health insurance and health care.

On the other hand, if PPACA is as bad as many readers here think it is, then I think it’s in their interest, and the country’s interest, for officials to get the exchange system and market rules implemented as quickly and as smoothly as possible, so we see that PPACA has had a fair shot to work and doesn’t. In that situation, the sooner groups like America’s Health Insurance Plans, the National Association of Health Underwriters and the National Association of Insurance and Financial Advisors roll out PPACA II alternative plans, the better.

On the third hand, letting PPACA wreck the commercial health insurance market without creating a viable alternative could be painful for both the patients and insurance brokers.

But the trip through what critics fear will be a Health Reform House of Horrors has been on the calendar for 40 years. Maybe it’s time to see what the house looks like and figure out whatever will come next. 

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