The story of the Patient Protection and Affordable Care Act of 2010 (PPACA) has been full of surprises.
The only thing that's really turned out the way I expected has been that the "three R's" risk management programs — the temporary PPACA reinsurance program, the temporary risk corridors program, and the relatively "permanent" risk-adjustment program — would have complicated, interesting problems.
On the one hand, I had a hard time imagining most of the other problems. It never occurred to me, for example, that setting up and running the exchange enrollment systems would be all that hard. It never occurred to me that state exchange committees would sit around talking about rare language translation services so long they'd put off working on the enrollment systems.
On the other hand, I never imagined some of the events that ended up savings the PPACA coverage expansion provisions from the brink of death. I never would have dreamed that John Roberts' Supreme Court would save PPACA from drafting and procedural problems — twice.
The PPACA exchange system could still end up pulling through and doing fine, even in 2017. You never know.
