Now the real sweat. Implementation.
While some of the more significant features of the bill won’t kick in until 2014, a lot will happen between two days ago and six months from now. The Huffington Post put together a great slideshow, highlighting the “Top 18 Immediate Effects.” (My colleague, Julie Barnes, told you about most of them last week, but never hurts to look at the pictures, too.) These provisions range from small business tax credits to donut hole rebates to allowing young adults to stay on their parents’ plans until age 26. Check it out. Here’s a convenient implementation schedule, courtesy of the American Medical Association. And the New York Times put together a great graphic that shows how reform will affect different types of people.
Health reform will certainly be a “bear to implement,” said Donna Shalala, the Health and Human Services secretary during the Clinton administration, because in many respects, the work just begins now. And while it's federal reform, the bulk of the work is left to the states. "In essence," explains Anthony Wright, executive director of Health Access California and regular contributor to the Treatment, "the bill spurs 50 different health reforms." Which means it's smart to get going.
Some states are not too thrilled. At least 36 state legislatures are facing attempts of one kind or another to "limit, alter or oppose selected state or federal actions, including single-payer provisions and mandates that would require purchase of insurance," and, on Tuesday, 13 state attorney generals got some attention when they sued the federal government. But others have embraced the opportunity and have already started the process.
The day after the President put his John Hancock on the bill, Maryland’s Gov. Martin O’Malley decided that Maryland would be a national leader in the health care overhaul and called for the creation of a task force to oversee federal reform implementation. The council, headed by Lt. Gov. Anthony G. Brown and state Health and Mental Hygiene Secretary John M. Colmers, will meet with doctors, academics and interest groups to determine how best to get reform up and running. O’Malley says that Maryland can save $1 billion over the next decade by implementing the federal reform measures. They are not wasting any time.
Over in California, the Assembly Health Committee passed several related bills the same day the President passed his. For example, AB270 (De La Torre) applied the federal health reform's ban on insurance rescissions. And AB2578 (Jones/Feuer) instituted rate review and regulation, a measure that while supported by President Obama, did not fit into the reconciliation package under budget rules.
We've got a lot of work to do. A task as great as this won't come easy, but it will come. As Wright concludes, this "effort to implement and improve is not just for good policy, but good politics. Those who support health reform can't be content with defending reform -- a good offense is a good defense."