The health care overhaul was signed into law last month but the work is far from over.
Over the next months and years federal and state agencies are charged with an unparalleled task: implementing hundreds of programs and provisions detailed in the new law.
While the health care bill does lay out specific guidelines for whats needed it does not always explain how to get there or how to overcome the obvious obstacles that stand in the way of smooth departures from existing laws and policies. Agencies are also up against strict deadlines.
Here are six of the biggest challenges they face as they figure out how to implement components of the new law in order of their deadlines:
High-risk insurance
The government must create insurance pools for people who cant otherwise get coverage because of pre-existing health conditions.
The challenge for the Health and Human Services department is to sync a new national plan with those currently in place at the state level and to ensure that theres enough funding to cover the large volume of people expected to enroll.
The deadline: July 1 of this year.
Existing programs
The new law also calls for the establishment of the Center for Medicare and Medicaid Innovation housed within the Centers for Medicare and Medicaid Studies.
Its purpose would be to establish pilot programs to test new ideas for reducing costs and innovating Medicare a system that has long relied on a traditional system. Challenging the way it has operated for decades may be met with reluctance or disapproval.
The center must be up and running by Jan. 1 2011.
State exchanges
The new law requires every state to set up a system to make sure the uninsured become insured. Online insurance exchanges or marketplaces must be created so that uninsured people can find the policy that works best for them.
Though each state can approach the task in a different way either by bringing it under the jurisdiction of an existing agency or creating a new one it wont be easy to sort out the logistics of processing applications and integrating each plan with state-run Medicaid programs.
The deadline for launching these exchanges is 2014.
Nationwide health plans
The Office of Personnel Management already handles insurance for all government employees making it the largest system of employer-sponsored insurance in the country.
Under the new law OPM will now also be tasked with creating at least two nationwide health insurance plans one of which must be a nonprofit to be made available through the state-based internet exchanges.
For a relatively small agency like OPM people fear the increased workload might spread its resources too thin.
The deadline: 2014.
Cost-cutting measures
The health care bill calls for the creation of a 15-member board called the Independent Payment Advisory Board which would make recommendations to the President and to Congress for how to cut costs and curb spending in the Medicare program.
Each member would have to be confirmed by the Senate for a six-year term and cannot be affiliated with relevant businesses or groups that might present a conflict of interest.
Obama might not have an easy time pushing his nominees through the confirmation process though and while the boards recommendations will not need Congressional approval it might be difficult to get Congress to along with their decisions.
The boards first set of recommendations is due in 2014.
Individual mandate
The Internal Revenue Service will be responsible for enforcing the individual mandate the requirement that people must purchase insurance or receive it through their employers or pay a fine.
The challenge for the IRS will be figuring out how to determine who has insurance and who doesnt without using many of the tools it normally uses for tax collection.
The deadline to start charging penalties is 2016.
Emma Dumain covers health care for Congress.org.
The health care overhaul was signed into law last month but the work is far from over.
Over the next months and years federal and state agencies are charged with an unparalleled task: implementing hundreds of programs and provisions detailed in the new law.
While the health care bill does lay out specific guidelines for whats needed it does not always explain how to get there or how to overcome the obvious obstacles that stand in the way of smooth departures from existing laws and policies. Agencies are also up against strict deadlines.
Here are six of the biggest challenges they face as they figure out how to implement components of the new law in order of their deadlines:
High-risk insurance
The government must create insurance pools for people who cant otherwise get coverage because of pre-existing health conditions.
The challenge for the Health and Human Services department is to sync a new national plan with those currently in place at the state level and to ensure that theres enough funding to cover the large volume of people expected to enroll.
The deadline: July 1 of this year.
Existing programs
The new law also calls for the establishment of the Center for Medicare and Medicaid Innovation housed within the Centers for Medicare and Medicaid Studies.
Its purpose would be to establish pilot programs to test new ideas for reducing costs and innovating Medicare a system that has long relied on a traditional system. Challenging the way it has operated for decades may be met with reluctance or disapproval.
The center must be up and running by Jan. 1 2011.
State exchanges
The new law requires every state to set up a system to make sure the uninsured become insured. Online insurance exchanges or marketplaces must be created so that uninsured people can find the policy that works best for them.
Though each state can approach the task in a different way either by bringing it under the jurisdiction of an existing agency or creating a new one it wont be easy to sort out the logistics of processing applications and integrating each plan with state-run Medicaid programs.
The deadline for launching these exchanges is 2014.
Nationwide health plans
The Office of Personnel Management already handles insurance for all government employees making it the largest system of employer-sponsored insurance in the country.
Under the new law OPM will now also be tasked with creating at least two nationwide health insurance plans one of which must be a nonprofit to be made available through the state-based internet exchanges.
For a relatively small agency like OPM people fear the increased workload might spread its resources too thin.
The deadline: 2014.
Cost-cutting measures
The health care bill calls for the creation of a 15-member board called the Independent Payment Advisory Board which would make recommendations to the President and to Congress for how to cut costs and curb spending in the Medicare program.
Each member would have to be confirmed by the Senate for a six-year term and cannot be affiliated with relevant businesses or groups that might present a conflict of interest.
Obama might not have an easy time pushing his nominees through the confirmation process though and while the boards recommendations will not need Congressional approval it might be difficult to get Congress to along with their decisions.
The boards first set of recommendations is due in 2014.
Individual mandate
The Internal Revenue Service will be responsible for enforcing the individual mandate the requirement that people must purchase insurance or receive it through their employers or pay a fine.
The challenge for the IRS will be figuring out how to determine who has insurance and who doesnt without using many of the tools it normally uses for tax collection.
The deadline to start charging penalties is 2016.
Emma Dumain covers health care for Congress.org.
