Until after the election — and maybe not even then
November's going to be the cruelest month. No matter who wins, we're not going to have any shining moment – no one day, no one decision – of sudden clarity on health care.
I say this as one sadly surrendering a cherished hope.
When the U.S. Supreme Court issued its ruling this summer, I wanted that to be definitive — and behold the morass of Medicaid and exchange decisions we're currently trudging through.
By the time I read that states were supposed to pick their essential health benefits benchmark plans by the end of September, I'd developed a nearly rabid yearning for a health-care-related issue I could point to and say, "Count on it — this will be decided then. The compass will be fixed and we'll navigate from there."
It didn't happen. Let me count the ways.
• Oct. 1 may or may not have been a deadline. Currently, HHS is saying it encouraged states to submit their selections by then but will work with those coming in later and does not now have a deadline for them to do so.
• On Sept. 12, a little more than two weeks before Oct. 1, Pennsylvania Insurance Commissioner Michael Consedine testified that no rule had been issued, proposed or final, that outlined details of the process. He still had major questions. As I write, this is still true.
• Pennsylvania has not, to date, selected a benchmark plan. It is not alone in this; only 16 states did make a selection by that time.
I've been talking to people about essential health benefits lately – if you want a quick overview, check the beginning of last week's live chat with David Vassilaros of Capital BlueCross.
More recently, lobbyist Vince Phillips of the Pennsylvania Association of Health Underwriters said this (among many other things) on the subject:
"My guess is that nothing will be figured out or announced until after the election."
This phrase is the carnival music of the whole merry health-go-round, and it brings me back to where I started. I think it is indeed likely that a lot of things won't be decided until the election.
I'm also increasingly convinced that a lot of things won't be decided after the election, or at least not anywhere nearly as quickly or cleanly as everyone would like. Health care is a big, complex system, and the changes answer to the same description. "Ponderous" is going to be the operative word.
Plus, Pennsylvania ponders. Our fair commonwealth is showing no signs of hasty decision-making – except that, you know, not deciding is in itself a decision.
Ostensibly that means we're heading toward a lot of default options, which I haven't heard anyone tout – "Hey, the feds are so on top of this that I think the best plan is to let them do all the decision-making instead of trying to do anything on our own!" – but then again, the feds are the ones making the rules, and they're not nearly finished yet. Unfortunately, by the time they are, the game may be over.
Then again – see previous comments on deadlines, timeframes and all manner of absolutes in PPACA.
About the election: Attorney Eric Athey of McNees Wallace & Nurick LLC did a short video summary on what would be needed logistically to repeal PPACA. It bolsters my above conclusions.
State Rep. Scott Perry has introduced a bill (HB 2655) that would prevent Pennsylvania from planning, establishing or participating in a state health care exchange.
Heather Stauffer covers Lancaster County, nonprofits and health care. You can reach her at 717-285-4237, 717-236-4300, ext. 289, or firstname.lastname@example.org. Follow her on Twitter, @StaufferCPBJ.