Reading PPACA, aka ObamaCare

Over on our Facebook page a user named Worth Noting asks:

Some friends and I are going to read the Health Care Law(s?) aka ObamaCare. We want to read the actual law – in it’s entirety. So ‘which’ one is the final real complete one?

Hi, Worth. ObamaCare was passed by Congress in two parts. The first part was the Patient Protection and Affordable Care Act (PPACA). It was H.R. 3590 in the 111th Congress. When it was enacted on March 23, 2010 it became Public Law 111-148. And when it was later printed in the United States Statutes at Large it gained one last citation as 124 Stat. 119. Any of those links will take you to the text of the law. It’s 906 pages.

Immediately after PPACA was enacted, a second law was enacted to modify it. That was the Health Care and Education Reconciliation Act of 2010 (HCERA), which was H.R. 4872 in the 111th Congress, Public Law 111-152, and 124 Stat. 1029. This one is 55 pages.

(Note that H.R. 3590 started off about an unrelated matter but the Senate co-opted this bill as a vehicle for passage of PPACA, so the legislative history of H.R. 3590 will be misleading.)

So that’s the law as enacted, the statutes, at 965 pages in all. As far as I can recall there haven’t been any substantive revisions by Congress since then.

When reading them, in many places throughout the laws you’ll see text like:

Section 1848 of the Social Security Act (42 U.S.C. 1395w-4) is amended —  in subsection (b) — in paragraph (4)(B), by inserting ‘, and for 2010 and 2011, dual-energy x-ray absorptiometry services (as described in paragraph (6))’ before the period at the end

In these cases, the Cornell Legal Information Institute is your friend. That is the best place to read the United States Code, to decipher what the Code was before and after the law changes it. To follow the citation in this example you’ll look for Title 42 section 1395w-4 of the United States Code, paragraph (b)(4)(B). It should by now show the law as modified by PPACA and HCERA.

In other cases you’ll see HCERA modifying PPACA — rather than previously existing law. In those cases it will look more like this:

Section X of Y, as added by section 1401 of the Patient Protection and Affordable Care Act and amended by section 10105 of such Act, is amended–

The other two branches of our federal government have something to say also.

You may also want to read the Supreme Court’s ruling upholding the law, decided June 28, 2012, National Federation Of Independent Business et al. v. Sebelius, Secretary Of Health And Human Services, et al. The reason I suggest this is that it provides a deep summary of the important mechanical parts of the law, meaning, how the policy is implemented at a practical level.

Congress often delegates to the executive branch authority on how to implement the details of new programs, things left undecided by Congress. These are called regulations. There probably have been hundreds or thousands of issued regulations (or rulemakings) by now from multiple agencies, including the IRS and HHS. You can search Regulations.gov for “PPACA” or “111-148” as a start: try this.

Worth Noting also asks:

Is there any way to ‘be notified’ of any other modifications or additions to this law – if they happen?

What makes tracking PPACA difficult is that while it’s a statute and you can read the PDF and all that, the PPACA is mostly instructions to the reader (you) about how to change existing law. This is normal. Laws rarely create entirely new sections of the U.S. Code. Instead they revise existing sections.

Since PPACA is so broad — remember it involves taxation, regulations of the insurance industry, cash payments to states, new programs, and so on — its not really one law but instead thousands of modifications to other existing laws plus new authorities for executive branch regulations. There’s no single law to point to that all future health-care-related laws or regulations will all cite necessarily.

And different parts become (or have become) effective at different times. So the law is still changing based on effective dates put into the original statutes.

You can track what Congress does here on GovTrack by tracking the Health subject area. FederalRegister.gov is a great place to track executive branch regulations, and they have a topic area just for Health Care Reform. Sunlight Foundation’s Scout tool can be used to track both legislation and regulations. (Thanks to Eric at Sunlight for reminding me about FederalRegister.gov and Scout. — Updated after this was first posted.) On Regulations.gov you can track proposed and final rules from the executive branch in the Food Safety, Health, and Pharmaceutical category. These subject areas cast a wide net. You may want to narrow it down depending on the parts of the PPACA that you are interested in.

Good luck!

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3 Comments

  1. Thank you so very, very much for your thoughtful and comprehensive answers to the questions I posted! We have surprisingly had more folks join our ‘reading group’ and the info you’ve provided is invaluable to us.
    Your answers generated another question (and am still ingesting the info above, so please excuse my taking a bit to get up to speed):
    If one is seeking a specific answer from the sources above – is there any sort of rule of thumb – as to ‘which part’ i.e. law or regulation – to look in? Or to know if it’s in both?
    For example: One of our reading group was told that the requirement for insuring those with pre-existing conditions only applies to children at this time.
    Does she start reading the law, or regulations, to seek her answer – as to whether this is correct or incorrect information?
    Obviously, reading the laws – AND the regulations as well – will be required – just trying to grasp the basics of ‘what’ is ‘where’ – since I had naively assumed the law itself contained everything.
    The sheer volume of material is a tad overwhelming – so, being able to at least comprehend these basic concepts – as well as, being sure our sources are valid – makes this more do-able.
    So thank you so much for your answers to the questions we asked.

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  2. “One of our reading group was told that the requirement for insuring those with pre-existing conditions only applies to children at this time. Does she start reading the law, or regulations, to seek her answer – as to whether this is correct or incorrect information?”

    The main policy goals will be found in the statutes, i.e. in the bills that Congress passes. (I say it that way because both statutes and regulations are law.) So I would expect you’ll find that answer in the statutes.

    But with a law so broad as PPACA, the statutes aren’t the final word in a practical sense. (They may be in a legal sense, but that may only be part of the picture.) The best way to know for sure what PPACA means right now is to look at what HHS or other reliable sources are saying as guidance for insurers and as explanations for the public.

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  3. I did a web search for “ACA and pre-existing conditions” and after looking at information at many sites, I find no distinction made between adults and children as to coverage. I feel the law applies to all ages.

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