Worthy read in the New England Journal of Medicine...
The Patient Protection and Affordable Care Act of 2010 (ACA) is arguably the most significant health legislation enacted in generations. As remarkable a political and policy achievement as it was, what the reform will actually accomplish is largely yet to be determined. Whether it slows the growth of costs, increases access to care, or improves the quality of care will depend on how it is implemented. Although major components of the law do not go into effect until 2014, the fate of the ACA depends on the outcome of four key events in 2012.
First is the 2012 state legislative sessions. One of the defining features of the ACA is the role it assigns to the states.1 States face important decisions about high-risk pools, regulating the commercial insurance market, Medicaid eligibility, creating a health insurance exchange through which small businesses and individuals can more easily compare and purchase plans, and under guidelines released in December 2011, defining essential health benefits packages. States not meeting certain requirements by January 2013 will lose control of the exchanges to the federal government. Although some states will be able to act administratively and through executive order — as Governor Lincoln Chafee (I) of Rhode Island has done — much of what they need to do requires legislation. The 2012 session is the last chance states have to act before the January 2013 deadline.
The vast majority of state legislative activity will take place between January and June. At least 40 states are scheduled to start their 2012 sessions by mid-February. Nearly 75% will have sessions lasting less than 6 months, more than a dozen will meet for less than 3 months, and four are not scheduled to meet at all. The timing of the state legislative sessions is particularly important given the timing of the second event, the Supreme Court ruling on the constitutionality of the ACA, which is expected to be issued by the end of June. Given that only nine states have sessions running into July, waiting until the end of June to see how the Court rules would be a risky strategy for many states, which may by default cede control of key elements to the federal government.