The story of the Patient Protection and Affordable Care Act of 2010 (PPACA) has been full of surprises.

The only thing that’s really turned out the way I expected has been that the “three R’s” risk management programs — the temporary PPACA reinsurance program, the temporary risk corridors program, and the relatively “permanent” risk-adjustment program — would have complicated, interesting problems.

On the one hand, I had a hard time imagining most of the other problems. It never occurred to me, for example, that setting up and running the exchange enrollment systems would be all that hard. It never occurred to me that state exchange committees would sit around talking about rare language translation services so long they’d put off working on the enrollment systems.

On the other hand, I never imagined some of the events that ended up savings the PPACA coverage expansion provisions from the brink of death. I never would have dreamed that John Roberts’ Supreme Court would save PPACA from drafting and procedural problems — twice.

The PPACA exchange system could still end up pulling through and doing fine, even in 2017. You never know.

See also: PPACA 2017: Cigna might sell through Virginia exchange

On the third hand, it’s hard to know how stable the exchange system will really be in 2017, or what would happen if the exchange system suddenly went poof in, say, June, when more information about form and rate filings becomes available.

See also: On the Third Hand: Rate filings

The federal government has been pestering big banks and insurers to come up with living wills, due to concerns about financial system risk.

Maybe the government ought to think harder about health system risk. Maybe it should make sure health care system players have some kind of plan for what everyone does next if the exchange system evaporates, or the online health insurance malls are still there but the shelves are empty. 

 

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