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Time to take fresh look at the health reform law


In considering the U.S. Supreme Court's decision last month to uphold IRS health care reform law regulations authorizing federal premium subsidies to the lower-income uninsured obtaining coverage in the federal exchange, we are reminded of a famous quote of Winston Churchill's.

Following a major Allied victory — after many setbacks — in late 1942, the British prime minister said that while the victory was not the beginning of the end, it was end of the beginning.

Similarly, we believe the Supreme Court decision allowing the continuation of premium subsidies to 6.4 million federal exchange enrollees, while not ending controversy over the health care reform law, may move the focus away from courtrooms and, we hope, toward Congress and regulators.

Certainly, the achievements of the Patient Protection and Affordable Care Act are significant and, we believe, indisputable. Through numerous provisions, especially the premium subsidies and the expansion of Medicaid, the law has made a huge dent in the number of uninsured.

Some of the benefits of that expansion of coverage, such as faster and probably better treatment of medical problems of the previously uninsured, are obvious. Other benefits — such as a reduction in uncompensated care, a cost that providers often try to shift to insured patients — while not as obvious are also important.

Given the benefits of the law and the Supreme Court ruling, we would hope that the focus will shift away from the courtroom and to Congress and regulators to develop a consensus on changes needed to improve the law.

On the regulatory side, much more needs to be done to simplify the current overly complex rules that require employers to report health care plan enrollment information to the government.

On the legislative side, we would hope lawmakers modify a provision that now requires employers to offer coverage, or pay a stiff financial penalty, to full-time employees, which the ACA defines as those working an average of 30 hours per week.

To us and to many others, that is not a real-world definition of a full-time employee and should, at a minimum, be bumped up to an average of 35 hours per week.

No doubt there are many parts of the law that can be improved, and we hope Congress works to do that in a careful and bipartisan way.