President Obama and others were quick to highlight that when health reform was passed, insurers would no longer be able to deny anyone coverage because they happened to have a pre-existing condition. That was one of those individual elements of health reform that was easy to communicate to the public, and that had a high degree of support among pretty much everybody but the insurance companies. Even the staunchest of conservatives wasn’t about to go on television and say “If you’re unlucky enough to have cancer, too bad. No insurance for you.”
Now, I could–and probably have, though memory fails me–focus on the implications of that provision, which takes effect for children under 19 beginning in September, and rolls out for everyone else in 2014, but instead, I just wanted to offer up a little lesson in how the law works. People are generally familiar with the “Schoolhouse Rock” version of how a bill becomes a law–but far fewer people understand what happens after the President signs the bill into law.
In a nutshell, the law that Congress passes and the President signs grants broad authority to the executive branch to create regulations. In the case of health reform, most of this authority is granted to the Secretary of Health and Human Services. If you look at the full text of the law, you’ll see a lot of sections that begin with phrases like: “The Secretary is authorized to…”, “The Secretary shall…”, and so forth.
In the Affordable Care Act, it is written that “a group health plan and a health insurance issuer offering group or individual health insurance coverage may not impose any preexisting condition exclusion with respect to such plan or coverage.” Of course, there’s more than that, including a section directing the Secretary to oversee the drafting of regulations relating to this aspect of the law.
Well, those regulations just got published in the Federal Register. You can read them here, if you’re interested. The point I want to make, though, is that what was essentially a single sentence in the health care law, has now been detailed in 21 pages of federal regulations that spell out precisely what can or cannot be done. And, of course, these regulations can be amended. So, you see, passing the law is only the beginning. Drafting the regulations is where the most action is.
For those of you who knew all of this already, forgive me for a remedial post, and just go read the regs. But it has been my experience that many people do not know such things, and I think that they deserve to. Consider it my community service for the week.