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It's time to start talking about changes to the ACA

Posted by John McDonough  May 27, 2013 09:27 PM

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A story in today's New York Times, "Partisan Gridlock Thwarts Efforts to Alter Health Law," deserves attention and I hope it gets some.

Just about every major law I have studied has been subject to repeated amendment and alteration after its passage, both federal and state. When I served in the Massachusetts legislature, "technical correction bills" were as normal as spring showers following passage of any major new law. It is the normal state of affairs with complex legislation. Once a complex new statute nears implementation, an array of issues, surprising or not, come to the fore in need of change or clarification. Usually, 99.9+% of the public has zero awareness that this goes on routinely, in ways big, small and hard to discern. It is the normal business of a legislative assembly. But the politically charged environment around the ACA has made that normal process inconceivable.

Still, even the Affordable Care Act has been subject to at least seven significant legislative modifications (not counting last summer's Supreme Court change relating to Medicaid) since its enactment in March of 2010.

Just like any other complex statute, there is a lot in the ACA that could use modification or clarification, felt by folks on both sides of the partisan divide. Some changes would be 100% unacceptable to Republicans, and many would be absolutely toxic to Democrats. And, many value-added changes would be potentially OK to both sides. Except, as the Times story makes clear:

 "... as they prowl Capitol Hill, business lobbyists like Mr. DeFife, health care providers and others seeking changes are finding, to their dismay, that in a polarized Congress, accomplishing them has become all but impossible. Republicans simply want to see the entire law go away and will not take part in adjusting it. Democrats are petrified of reopening a politically charged law that threatens to derail careers as the Republicans once again seize on it before an election year. As a result, a landmark law that almost everyone agrees has flaws is likely to take effect unchanged."

I don't think the process to find politically acceptable modifications to the ACA can start on Capitol Hill. This process needs to start, though not there. It needs to start in the world of the think tanks and policy groups where experts operate with more degrees of freedom than  permissible on Capitol Hill. The effort may not even bear fruit for some time to come, maybe not even for several years.

Last week, I had breakfast with Prof. Larry Susskind of MIT and Harvard Law, and the director of the Consensus Building Institute that attempts mediation in some of the hottest and bleakest disputes on the planet. "When things are most bleak," he said to me, "that is precisely the time to sit down and attempt to negotiate."

Why not?

This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »

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