Web Chat: First Anniversary of the Health Care Law

On the first anniversary of the health care law, Brookings expert Kavita Patel reviewed the steps taken thus far toward implementation and answered your questions about the prospects for more action on Capitol Hill.

The transcript of this chat follows.

12:30 Seung Min Kim: The health care law has had quite a year since President Obama signed the bill one year ago today. Here with me now is Brookings expert Kavita Patel to answer your questions on the law’s implementation so far and upcoming congressional action on it. Welcome, Kavita.

12:31 Kavita Patel: Thanks for having me!

12:31 [Comment From Paula: ] Have individuals seen any benefits from the law?

12:32 Kavita Patel: Great question- people have already seen benefits- folks with pre-existing conditions now have access to health care as well as young adults who can join their family plans.

12:32 [Comment From Andrew (DC): ] Many states are seeking waivers. Can you explain?

12:33 Kavita Patel: Insurance laws vary state to state and that can create some discrepancies which are being worked out with waivers; in addition, some states are much smaller than others and might have different market forces which also affect the dynamics requiring a waiver.

12:33 [Comment From Erica: ] In terms of more action on Capitol Hill, what do you expect to see happen in the coming months?

12:35 Kavita Patel: Capitol Hill will likely engage in a great deal of oversight as well as thinking through the issues of implementation that might still require further Congressional action. For example, physician payment reform issues are still being dealt with as well as all of the activity to appropriate money for various programs within health reform.

12:35 [Comment From Amy P.: ] Hi Kavita! Thanks for taking my question. Why has this law been so divisive among Americans? Do you think we have a “spin” problem, or is the law really that flawed?

12:37 Kavita Patel: The law has not been well understood, which is not a surprise to me, but that means that the people who provide health care everyday need to have an opportunity to digest it and then be part of the community that helps to explain it to their patients and others. So it isn’t really “spin” but more that change can take some time to process and explain.

12:37 [Comment From Frank G.: ] Do you think health care should be a state rather than federal issue?

12:39 Kavita Patel: The Affordable Care Act is both a state and federal issue – in order for it to succeed, one can’t be done without the other. State agencies and federal agencies are speaking to each other with a frequency we have not seen in a long time and lots of folks are working at local, regional and state levels to think through the implementation.

12:39 [Comment From Brian R: ] About ACO ‘s — providers appear confused or reluctant when discussing implementation plans — what is the difficulty here?

12:42 Kavita Patel: I am a provider myself and I just went to a national meeting of my primary care colleagues and the room was packed with doctors wanting to learn more about accountable care organizations and how they can be part of leading the effort, so I am finding more and more people eager to discuss it. The confusion in part might be from understanding where they have a role in framing the discussion. I am hoping that more providers will express a desire to be clinical leaders in delivery system reform.

12:42 [Comment From Ross Kinzler: ] How does the individual mandate’s fine work on the Form 1040 if one spouse is covered by health insurance but other spouse is not?

12:44 Kavita Patel: Not sure if i completely understand the question but if one spouse is covered through an employer or a plan in the exchange, the other spouse (as long as they are recognized as a U.S. citizen or legal resident) also needs to show proof of coverage through your tax return. The fine is to the individual, not the couple.

12:44 [Comment From Sally: ] As a doctor, how do you feel about the new requirement that everyone buy health insurance? And when does that provision kick in anyway?

12:46 Kavita Patel: As a doctor, I have seen the effects of people who need care and cant get it; I want to make sure that they have access to high quality health care and that is what I am excited about. The provision for insurance goes into effect in 2014 and there is a great deal of activity at the state level right now to get awareness and education out there.

12:46 [Comment From Pam: ] My son is in college and I’d like to keep him on my health insurance plan. Can I do that now?

12:47 Kavita Patel: Yes you can- the best thing to do is contact your insurer directly. As long as your son is in the same state, it should be easy to do.

12:47 [Comment From Ben – NOVA: ] Can you address how this law will impact small business owners?

12:48 Kavita Patel: Small business owners will receive a tax credit if they offer their employees health insurance; they do not have to offer this; so doing so is entirely voluntary.

12:49 [Comment From Wes: ] While the ACA is going to help get millions of Americans insurance who are currently uninsured, there will still be a gap of several million without insurance. How can we close this remaining gap?

12:51 Kavita Patel: Great question- we know that while there will be people without access, the Affordable Care Act is a start to making sure that we have improved access to care. The next steps will involve looking at:

1. why people are still uninsured;

2. what are the barriers;

3. what solutions do we need- congressional action (perhaps if we are thinking about immigration issues), executive branch, etc.

12:51 Seung Min Kim: Kavita, can you talk about the legal challenges facing the health care law — more specifically, when/if the Supreme Court will address the issue and how you think they’ll rule, considering the current makeup of the Court?

12:54 Kavita Patel: The Supreme Court calendar is set pretty far in advance so I am not sure we will see any action this year. I think it is fairly obvious that it will come before the Supreme Court at some point. The composition of the court has been a large source of discussion, but the argument before the court is really about the merits of the mandate from the legal basis of the commerce clause etc. I do feel that the mandate will stay in place.

12:54 [Comment From Tom: ] Why is there still so much confusion about health care law still even a year later?

12:56 Kavita Patel: Good question. There are several issues at work here – it is one of the biggest domestic policy laws we have seen in several decades, and that is not easy to digest in one year. But we also know that until people start seeing the effects in their day-to-day lives, they will probably not really understand what is in the law that affects them. So I have been trying to help other providers understand what is in there and hopefully then they can talk to their colleagues, patients, etc.

12:57 [Comment From Susan in Maryland: ] Why did Maine insurers get to reduce the amount of money spent on health care?

12:58 Kavita Patel:The issue with Maine is about a waiver to look at how the money is spent. It allows the state’s insurance commissioner to have flexibility with the insurance plans (there aren’t that many in the state) in Maine to ensure that people don’t lose insurance or access to care as a result of provisions around the medical loss ratio. This is a good thing- the federal government working with states to ensure that patients don’t experience unintended consequences.

12:59 [Comment From ron: ] Is it too soon to tell whether the health care law is performing as expected, if it’s reducing the cost of health care, and if it’s expanding the availability of health care?

1:01 Kavita Patel: There are certainly many provisions which haven’t been implemented yet and some that deal with helping to change the way we pay for health care, so the cost pieces are still coming. We do know that millions of young adults and others with pre-existing conditions or high risk health conditions now have access to health care that they didn’t have before. So we are seeing an expansion in availability.

1:01 Seung Min Kim: And that’s it for today — thank you all for such a lively discussion! And a special thanks to Kavita for her answers and insight.