Expert Sources: Affordable Care Act
PROF. MARY ANN CHIRBA
BOSTON COLLEGE LAW SCHOOL
(617) 552-4381 (office)
(508) 320-5175 (cell)
Chirba is an expert on the Affordable Care Act and has written on the law’s employer mandate. She lectures on various health law issues at area medical schools and hospitals. She earned her doctorate of science in health policy and a master's in public health from the Harvard School of Public Health, and her J.D. from Boston College Law School. A former litigator, she has also been certified by the American Health Law Association as a mediator and arbitrator. She is co-author of Health Care Reform: Law and Practice (M. Chirba, A. Noble, O’Melveny & Myers; Lexis/Matthew Bender 2013), which provides a section by section analysis of statutory and regulatory compliance obligations under the Affordable Care Act.
ADJUNCT FACULTY MEMBER ALICE NOBLE
BOSTON COLLEGE LAW SCHOOL
(617) 893-8073 (cell)
As both a practicing attorney and as a legal educator, Noble’s career has been focused on issues of health law and policy. She is an expert on the Affordable Care Act and co-author of the recently published Health Care Reform: Law and Practice (M. Chirba, A. Noble, M. Maddigan; Lexis/Matthew Bender 2013), which provides a section by section analysis of statutory and regulatory compliance obligations under the Affordable Care Act. She holds a law degree from Villanova University School of Law and a master of public health degree from Harvard School of Public Health. Noblle was a fellow in medical ethics at Harvard Medical School and a Senior Researcher at The American Society of Law, Medicine & Ethics. In addition to teaching at Brandeis University and Boston College Law School, she has taught numerous courses at Harvard School of Public Health and Tufts Medical School. She is a senior lecturer in the Legal Studies Program at Brandeis University and adjunct lecturer at Brandeis University’s The Heller School. She has also taught at Harvard School of Public Health and Tufts Medical School. Courses taught include Genetics, Law, and Social Policy, Health Law and Ethics, Health Law and Policy, Advanced Legal Writing, Law and Public Health, Managed Care Law and Regulation, among others. She has a number of peer-reviewed publications on topics such as genetic technology, law and ethics; medical malpractice; managed care; and hospital law. She is a contributor to the Health Affairs Blog and Health Law Professors Blog. Noble has been an invited speaker on various matters, including national health care reform.
With the White House coming under increasing pressure to allow consumers to keep their old healthcare plans, an idea supported by President Clinton, two of the nation’s experts on the Affordable Care Act say it’s just not possible.
“Unfortunately, for those people who face losing their present coverage and would prefer not to, it is not feasible to allow them to retain it on anything more than a temporary basis," says Boston College Law School Professor Mary Ann Chirba, J.D., D.Sc., M.P.H. “Doing so for a longer period of time would destabilize the ability to finance the ACA's overall expansion of coverage, in terms of both number of people covered and required minimum benefits.”
Hundreds of thousands of consumers are scrambling to find new health insurers after having their policies cancelled because those policies didn’t meet the minimum standards of the new healthcare law. Adding fuel to the fire were yesterday’s comments from President Clinton, a supporter of Obamacare, who said people should be able to keep the health insurance they have. But Professor Chirba and Boston College Law Professor Alice Noble, J.D., M.P.H, who have read all 907 pages of the statute line by line and authored a book about the ACA titled Healthcare Reform: Law and Practice, say while the idea may be politically popular, it’s just not practical.
“I suspect that as President Clinton suggests this approach in his effort to quell an increasingly heated political debate,” says Professor Chirba, “he does understand the logistical infeasibility of doing so, given his Administration's ambitious effort to enact the Health Security Act in 1994, which employed many of the strategies used by the ACA.”
Adds Professor Noble, co-author (with Professor Chirba) of the articles, Life is a Highway: Severability of the Affordable Care Act and On the Individual Mandate Argument: Beyond Uncompensated Care: “What President Clinton suggests would likely need additional legislation--something that seems quite unlikely, given the Congressional aversion to revisiting --even to improve-- the Affordable Care Act.”
The duo say allowing hundreds of thousands to keep their old insurances policies, as a growing chorus is demanding, would undermine the need for risk distribution the healthcare law is built on.
“You need healthy people in the insurance pool for the purpose of spreading risk and distributing the utilization costs of older and sicker people in that pool,” says Professor Chirba. “This is a standard concern when insuring against any kind of loss. It’s analogous to needing safe drivers in the risk pool because a pool with only high risk drivers could not distribute the costs of covering claims adequately. If risk is too concentrated, lots of things unravel financially.”
Two of the nation’s prominent experts on the ACA say initial problems are to be expected, should be viewed with concern, and that embattled Health and Human Services Secretary Kathleen Sebelius should stay on.
“There are real problems with Healthcare.gov - but they are by no means insurmountable,“ says Boston College Law School Professor MaryAnn Chirba, J.D., D.Sc., M.P.H. “In fact, given the complexity of what is being launched, it is not surprising that there have been problems in achieving lift-off.”
Professor Chirba and fellow Boston College Law Professor Alice Noble, J.D., M.P.H have read all 907 pages of the statute line by line, read thousands more pages of regulations, and have analyzed both in a one-thousand page book titled, Healthcare Reform: Law and Practice (With O'Melveney & Myers, published by Matthew Bender; Nov. 2013).
“A well designed federal Marketplace is essential to full implementation of the insurance market reforms of the Affordable Care Act,” says Professor Noble, co-author (with Professor Chirba) of the articles, Life is a Highway: Severability of the Affordable Care Act and On the Individual Mandate Argument: Beyond Uncompensated Care.
Both Noble and Chirba agree the extensive problems of the website are concerning, but not surprising given the law's complexity and its many interlocking components.
“Designing the exchange was complicated to begin with for several reasons,” says Professor Noble, “including the lack of clarity about how many states would run their own exchanges, how many would participate in the ACA's Medicaid expansion program and how many insurers would compete in a given state or region with further variations in the number, kinds and costs of available plans.
The duo reminds us the exchanges are intended to spur functioning insurance markets in every state so that competition among insurers can give consumers more choices at better prices. For this to work, however, consumers must be able to "shop" and evaluate the costs and benefits of different plans.
“A system needs to have good decision support tools for those new to buying or even having health insurance so that not only premiums but deductibles and co-payments are properly included into a consumer's monthly costs, which can vary by state and applicant age,” says Professor Chirba. “This goes to system design, not to the need for the system to begin with. For those who manage to get into the system, it has been difficult to get a firm handle on this information and early efforts to fix this have introduced new problems. Again -- system design as opposed to legal or policy issues. The list of problems goes on - and it is a long one - but they largely pertain to making a very complicated system do the very complicated things it needs to do.”
Professors Noble and Chirba say Secretary Sebelius should stay the course and ignore the increasing calls for her to resign.
“Lost in all of this is the remarkable job Kathleen Sebelius and HHS have done in getting so many aspects of the ACA up and running,” says Professor Chirba. “It is not as if the ACA was passed in 2010 and HHS had a full three years to focus on nothing but building what we now realize is an inordinately complex system. In the intervening years, HHS has juggled so many regulatory concerns and met so many other shorter deadlines for other incredibly complex matters such as Medicare reforms. Many criticize the numerous ACA delays along the way. Personally, I am staggered that there have not been more.”
With the government extending the enrollment deadline by six weeks to March 30th, Professors Noble and Chirba say while this date change is not solely attributable to the current technical problems, further extensions may nevertheless be granted if current technical dilemmas persist through Thanksgiving. In the end, though, as the federal government brings in its “A” team to fix the website problems, the two scholars expect full implementation – eventually.
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