Reform of the Patient Protection and Affordability Care Act

Junior (College 3rd year) ・Healthcare&Medicine ・APA ・7 Sources

The U.S Constitution provides the government the “police power” to provide health, welfare, and safety to the people through enacted laws and frameworks. As such, in an attempt to improve the health and well-being of the people, the Patient Protection and Affordable Care Act (PPACA) became a law in March 2010 at the federal, state, and local levels of the government (Kantarjian¸ 2017). Since then, the law has raised debate among Americans who question its credibility regarding economic and health effectiveness. With a mandatory penalty imposed on individuals and private organizations not participating in the program, many feel that PPACA is associated with economic burden, especially among tax-paying citizens (Manchikanti, Helm, Benyamin, & Hirsch, 2017). These issues can be addressed through a reform of the original document which involves several stages.
The first step toward initiating changes to the PPACA might be to initiate the proposal events. This entails the U.S Department of Health and Human Services (HHS) initiating different reform processes in consideration of its plans and priorities, statutory mandates, and data regarding the petition. According to Ekman (2013), the agency initiatives usually originate from things like accidents, new technologies, and scientific data. In the case of PPACA, the proposals for change could be based on economic data revealing its economic impacts on the people. The second step is to determine whether there is a need for a rule or not. In the case of the policy, it will be important to provide a rule since the policy has a great impact on individuals as well as small and large entities (McKinney, 2015). The HHS is expected to prepare an economic impact analysis to review the economic impact of the reform. Since a rule is needed, the next step is to prepare the proposed rule (Conrick, 2005). It will be necessary to write down the needed “change/deletion/addition” of the law in the proposal which is accompanied with a request for the public comments.
After preparing the proposal, the health agency is expected to send it to the Office of Management and Budget (OMB) for review. Under the Executive Order 12866, the OMB is mandated to review those rulemakings that are very important to the state (Berenson¸ 2007). The PPACA is significant as it includes every American and is implemented on different facets of health including the Medicaid (American Hospital Association, 2015). After reviewing the proposal, the OMB publishes the proposed rule in the Federal Register; this should be in accordance with the Administrative Procedure Article 5, Cap 553 (Conrick, 2005). The proposal should then be placed in the public domain by publishing the proposal in a national gazette for comments. According to the Public Law No. 107-347, it is important that agencies consider public comments regarding a proposed rule through electronic comments. The period for this process should be 60 days which is stipulated by the Executive Order 12866 (Conrick, 2005).
After receiving reviews from the public, the health agency should prepare the final rule to be presented to the OMB for review. The OMB then permits the health agency to pass the rule to the Congress to have the final review and analysis (ICF Consulting¸ 2003). The Congressional Review Act requires that every government agency provide Congress with a proposed rule for their review and make a final recommendation. The PPACA change proposed must be reviewed by the OMB before it goes to the Congress for debate (ICF Consulting, 2003). If the Congress votes for the proposed change, then the PPACA is changed and the reforms take effect after a period of 3 to 6 months.


American Hospital Association (AHA). (2001). Patients or paperwork? The regulatory burden facing America’s hospitals. Chicago, IL: AHA. Retrieved December 15, 2006, from
Berenson, R. A. (2007). Separating fact from fiction: A new role for Health Affairs. Health Affairs, 26 (7), 1528– 1530.
Conrick, M. (2005). Health informatics: Transforming healthcare with technology. Southbank, Vic: Thomson Learning Australia.
Ekman, L. D. (2013). Participating in Rulemaking: How Your Organization Can Influence Federal Policy. Clearinghouse Rev., 47, 343.
ICF Consulting. (2003). The Reg Map: Informal Rulemaking. Retrieved from http://
Kantarjian, H. M. (2017). The Affordable Care Act, or Obamacare, 3 years later: A reality check. Cancer, 123(1), 25-28.
Manchikanti, L., Helm, I. S., Benyamin, R. M., & Hirsch, J. A. (2017). A Critical Analysis of Obamacare: Affordable Care or Insurance for Many and Coverage for Few. Pain Physician, 20(3), 111.
McKinney, R. J. (2015). Federal Administrative Law: A Brief Overview. Law Librarians' Society of Washington, DC.

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