Before passage of the president’s health care legislation in March, House Speaker Nancy Pelosi (D-CA) infamously exclaimed that “we have to pass the bill so that you can find out what is in it.”  It has now been months since the Patient Protection and Affordable Care Act became law, and as Heritage expert Stuart Butler explains in a recent paper, the consequences of the bill remain to be determined. Moreover, the ambiguity of the legislation and the amount of decision-making left to administrators means that several controversial questions surrounding the legislation remain unanswered.

Butler highlights the following areas as those in which Americans may find that critical future decisions could drastically change the direction of the health care overhaul:

  • Health Exchanges. “…the design and control of health exchanges is likely to become one of the federal–state battlegrounds that will play out over the next months and years. And right now, given the language in the legislation, the federal government has the upper hand. If indeed the federal government succeeds in molding the exchanges to the full extent that would be possible under the legislation, the result will be a system that differs little from a national exchange with strong federal control.”
  • The Public Option in Disguise.  “…the provision in the legislation to create a network of national private plans is likely to become another battleground as it becomes clearer that the “private” national plans will be so regulated and administered that they are virtually indistinguishable from a public option…”
  • The Fate of Employer-Sponsored Insurance.  “Despite all the talk of avoiding any disruption of the current system of employer-sponsored insurance, the legislation actually seems destined to accelerate the steady decline of that form of coverage.”  The extent to which employers are encouraged to drop health benefits for employees will be determined by future policy decisions.
  • Bending the Cost Curve in Health Spending. Obamacare did not tackle one of the main drivers of rising health spending, which is the insulation of the insured from the costs of health services.  Writes Butler, “That underlying economic reality about health care is likely to be exacerbated by the health legislation. Indeed, most authorities, including the Congressional Budget Office (CBO), have forecast that the spending trend-line will go up rather than go down.”

Though the president’s health care overhaul is now law, its future is anything but certain due to the repeal efforts and legal challenges it will face.  Even if the legislation does remain in place, the details and consequences of its provisions are not set in stone.  Crucial aspects of the care Americans receive, from who will make treatment decisions to cost and access to services, remain in the hands of lawmakers and the administrators who will implement the law in the months and years to come.

To learn more, read Butler’s lecture, “Why the Health Reform Wars Have Only Just Begun”.