Early Changes

Abstract

Some aspects of the patient protection and Affordable Care act of 2010 started like a stumble-rama. For example:

• The new health care law in 2010 created temporary insurance exchanges. These exchanges were established nationwide to sell policies to people with pre-existing conditions who were having difficulty getting coverage from private insurers. A government actuary predicted 375,000 enrollees would pour into the exchanges by the end of the year. Only 12,000 people enrolled. Officials blamed lack of awareness and rates that were too high. They staged a publicity campaign, and lowered rates. Enrollment rose to 50,000.

• Another early element of the law prohibited health insurance companies from turning away children with pre-existing medical conditions. In response, major in surers were driven by financial fears to completely stop selling policies that just covered children.

• And still another early reform gave the government power to review insurance rate increases of more than 10 percent. What most people failed to realize is that the law made little provision for doing anything about excessive rate hikes, other than look at them, and many states were incapable of even doing that.