Analysis of the Rule-making Process within the Affordable Care Act

This report provides a comprehensive analysis of the rule-making process within the Affordable Care Act (ACA), also known as Obamacare. It examines the ACA's enactment, which involved two laws, and the role of the Health and Human Services Secretary in developing regulations. The report discusses potential challenges and modifications to the rule-making process, particularly concerning the definition of 'standardized nursing care' and its financial implications for healthcare organizations. It outlines market reforms, coverage expansions, and the impact of the ACA on federal revenues and expenditure. The report also explores the role of congressional oversight, including various options for monitoring and influencing the ACA's implementation. References to legal cases and the Affordable Care Act are included.

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The Rule-making Process within the Affordable Care Act
The Affordable Care Act which is also known as the Obamacare brought fundamental
changes to the healthcare coverage, regulation and insurance all over the United States. The
Act was either strongly supported or opposed and this saw its enactment process to be
controversial and unorthodox. A fundamental element of the enactment process is that the
Act is not the only health care bill which became law. Instead, it is composed of two laws
which include the Patient Protection and Affordable Care Act (Pub. L. No. 111-148, 124
STAT. 119) and the Health Care and Education Reconciliation Act of 2010 (HCERA) (Pub.
L. No. 111-152, 124 Stat. 1029. The enactment of the Affordable Care Act occurred on
March 23, 2010 in order to reconcile the differences between the House version and the
Senate bill regarding healthcare legislation. The Act is intended to expand and reform health
coverage. The Health and Human Services Secretary is the one responsible for the
development of the body which regulates the Affordable Care Act. The U.S government has
proposed rules and generated various guidance documents for the clarification and
redefinition of the rules.
The organization of Good Health may seek to modify the rule making process under
the Act so that the Act adopts the narrower definition of the phrase 'standardized nursing care'
that was adopted by the Fifth Circuit Court of Appeals instead of the broader definition
adopted by the Ninth Circuit Court of Appeal. This is because the broader definition poses
increased costs to the organization as well as the clients for the organization which will
ultimately become detrimental to the provision of health care. This means of modification
may be hectic to be relied on by the organization because it would involve taking back the
Act to the legislature for amendments. However, if they successfully convince the
parliamentarians, then their grievances would be successfully addressed.

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Judicial challenges for agency action
Overview of Health Reform Law
The Affordable Care Act has a significant effect on federal revenues and expenditure.
The law includes expenditure of subsidizing the purchase of coverage for health insurance
through the exchanges and increased programs for the expansion of Medicaid. The Act also
provides for appropriate funding of temporary programs to foster for more access and
funding available for targeted groups. The costs required to expand private and public health
insurance coverage as well as other expenditure are catered for by revenues generated from
new fees and taxes as well as savings from from health care delivery and payment system
reforms that are designed for reduction of expenditure on Medicaid and more programs of
federal health care.
The Act is supposed to make provisions for affordable health care. It is for this reason
that as the administrator of Good Health, I would seek for judicial review in the rule under
the Act's standardized nursing care because it injures the organization's finances as well as an
extra cost to the clients. The organization is more likely to be successful if it moves to the
court to convince the court to be able to adopt the narrower definition of 'standardized
nursing care' as was adopted by the Fifth Circuit Court of Appeal even though this is not the
definition which was adopted by the Act. This move would see the organization offset the
threat on its finances and those of its clients.
Market Reforms and Coverage Expansion: Pre-2014
The law provides for various temporary programs in order to improve the funding and
access for the targeted group. They include temporary pools of high risk for uninsured
individuals who have pre-existing conditions, a reinsurance program of reimbursing

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employers for costs of health insurance claims for retirees between 55 and 64 years old and
small credits for business tax for firms having less than 25 full-time equivalents (FTEs) as
well as average wages less than $50000 offering health insurance. Additionally, before 2014,
it is voluntary for states to expand their relevant Medicaid programs.
Market Reforms and Coverage Expansions: Beginning in 2014
This signifies the major reform and expansion provisions under the ACA. States
should establish exchanges of health insurance which avail access to plans of private health
insurance that have standardized packages of cost-sharing and benefits for small employers
and elligible individuals. In 2017, states may permit larger employers to buy health insurance
via the exchanges, but it is against the requirement. The Health and Human Services
Secretary establishes state exchanges not creating their own exchange that is approved.
Other than the expansion of the coverage for private health insurance, the ACA
requires Medicaid programs of the states to expand coverage to every non-elderly legal
residents and non-pregnant residents who have an income of not more than the federal
poverty level (FPL) of or those who risk to lose their matching funds of the federal Medicaid.
The federal government initially covers the costs in their entirety for this group with the
percentage of federal matching reduced to 90% of the expenses by 2020. The Supreme Court
found in National Federation of Industrial Business v Sebelius that the expansion under
Medicaid was in violation of the Constitution when it threatened states of losing their existing
matching funds of the federal Medicaid in case of their failure of their compliance with the
expansion. This expansion was specifically in direct contravention of the United States
Constitution under Articles 1, 2 and 3.
Implementation and Oversight

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The implementation of the Affordable Care Act begun upon its enactment in March
2010 and has to continue over few years to come. It entails all the major stakeholders in
health care, including state and federal governments, and insurers, employers as well as
health care providers. It is the responsibility of the Health and Human Services Secretary to
implement and oversee the key provisions of the Affordable Care Act. Other federal agencies
also have significant administrative and regulatory responsibilities under the Affordable Care
Act. The Secretary and the relevant federal officials are tasked to take certain actions within a
given date. The Affordable Care Act requires states to expand their Medicaid coverage and
they are expected to establish the exchanges despite the poor economies and budget
shortfalls. Employers also have a role in the ACA implementation.
Congressional Oversight
Congress has a variety of options in its oversight of the ACA's implementation,
including agency officials' confirmation hearings, oversight hearings, meetings and letters to
agency officials as well as the Regulation Affairs and Office of Information pertaining to
particular comments, rules on proposed regulations as well as new legislation on specific
rules. Committees, Congress and individuals members may also request inspector general
federal offices or Government Accountability Office for actions to implement or decisions of
agencies to implement specific ACA provisions. Congress may also include provisions in the
agency appropriation bills to direct or prevent the enforcement or development of particular
regulations. As the administrator of Good Health, I would recommend this option of seeking
the assistance from Congress for the repeal of the rule by the ACA Act on the standardized
nursing care as it is detrimental to the organization's finances and also because it would mean
extra costs for the clients. Congress is a very powerful political institution. Therefore if Good
Health can manage to seek its intervention and assistance in the interpretation and redifinition
of 'standardized nursing care', then such a move has a higher probability of success.

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References
Administrative Procedure Act.
Affordable Care Act 2010
Patient Protection and Affordable Care Act of 2010 (Pub. L. No. 111-148, 124 STAT. 119).
Health Care and Education Reconciliation Act of 2010 (HCERA) (Pub. L. No. 111-152, 124
Stat. 1029).
National Federation of Industrial Business v Sebelius.
United States Constitution.

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