Forget about the cratered launch of ObamaCare. There is one sign of life still among the rubble. That sign of life is the free market.

There are any number of new companies that have sprung up to take advantage of gaps in the sprawling new law.

Extend Health, Inc. is a start-up that launched one of the first private insurance exchanges. Last year it was sold for nearly a half billion dollars.

How about Castlight Health? Their products put the transparency back into healthcare costs so consumers and employers can make more informed decisions about their costs and healthcare utilization.

And there’s Benefitter, Inc., whose software and support products help employers and their workers navigate the murky waters of Affordable Care Act regulations.

All of these entrepreneurs share one thing: They saw a big change coming and decided to manageit, rather than being managed by it.

At Chaddsford Planning Associates we’ve been part of a similar phenomenon. In the 1990s, President Bill Clinton pledged to “end welfare as we know it.” 

The cry against welfare reform, passed by Congress in 1996, was not unlike what we’ve seen with the Affordable Care Act. Each was a radical re-working of the social safety net.

I launched Chaddsford Planning the following year to take advantage of the fact that states, recipients and the private sector were facing a compliance issue with very little in the way of support.

Our first client was a trade association representing the food retailing industry. That was followed by another lobbying group representing the financial industry. Then came a major transaction processor. And a group of states. Then more states. And an equipment manufacturer. Then a company from France wanting to take advantage of its experience supplying product to that country’s social safety net. And then an Asian company wanting to sell to Hispanic Americans. And on and on.

The business environment changes all the time. If you’re a business you either take advantage of that, or be taken advantage of. That transaction processor? We helped develop two products that threw off $25 million in the first six months. The equipment manufacturer? A contract for 10,000 units within the first four months.

During the past 16 years we’ve helped more than 30 states plan for the adoption of electronic payment technology to replace their outdated paper benefit payment systems. All part of modernizing how we delivery social benefits. 

The next time change hits your business, tackle the problems it creates,  but don't stop there. Look for the opportunities that change can create for you.

As for the Affordable Care Act, who would have thought that a law, which at its core essentially converts one-sixth of the U.S. economy into a public utility, could rile up the animal instincts of the free market?

Welcome to America!

Consultants get a bad rap. Sometimes deservedly so. I thought about this recently amid the revelations of the government’s failed www.healthcare.gov website. It appears that rather than hire a consultant to manage the development of the site, the Department of Health and Human Services allowed one of its own agencies to oversee the development and testing of the website.

This is not a rip-on-ObamaCare riff. But it is about what happens when a technology project goes awry. And it’s about whether you should hire a consultant and when it makes sense to do so.

Here are just three examples of when hiring an outside consultant makes sense. First, hiring a consultant makes sense if you have a lack of staff time to allocate to your project. I know of few organizations that have time on their hands. Bringing in a consultant makes sense if you have a one-off project and not enough time. If you have a continuing project it makes sense to hire your own staff.

A second reason to hire a consultant is if you or your staff lacks the expertise to get the job done. This takes some soul-searching on your part. But be honest. Who has the time or inclination to do everything? If you’re a technology-driven company and you need a sales portfolio prepared, it makes sense to go to a sales consultant.

A third reason to hire a consultant is to put “another set of eyeballs” on the problem. In business we often spend so much time on a project that we develop what I call a proprietary interest in it. We built it; we own it. Having employees invested in a project is good. However, being so invested that you can’t see the flaws in your baby isn’t so good. A consultant can come in and give you an honest appraisal of where you are in the project and how to bring it in for a landing.

These are basically the three reasons people hire us. There are others, but most of our calls come when nobody on board has the time or the expertise, or the objectivity to bring a business development project to conclusion.

For example, for several years we were retained by a think tank called the Center for Health Transformation. CHT was at the time a think tank based in Washington, that provided thought leadership on how to use healthcare technology to improve the quality and lower the price of healthcare.

Our job was to interview and report on notable uses of cutting edge technology in the healthcare industry, including accountable-care organizations, health information exchanges and healthcare analytics. Our job was to produce a series of white papers on health IT for the client.

CHT didn’t hire us because of a lack of expertise. There were more health IT policy experts in their hallways than the hallways of Congress.

But CHT lacked one thing: time. In the fast-paced DC environment they lacked the time to methodically dig out the necessary information and produce attractive crying-to-be-read white papers. That’s what we did, bringing the objective eye of a reporter and the sharp pencil of an editor to the job.

Some of those white papers are available for viewing on this site.

Not all jobs have the crushing deadlines, technical complexity and inbred proprietary design require a consultant. But a lot do. (DHHS, are you still reading?)

So here’s some free advice from the consultants: If your job is in that category, stop going around in circles and start looking for help.

Now start the meter.

There is a new healthcare product on the market in Michigan and it could end up saving consumers thousands of dollars, according to the vendor. And it’s almost deceptively simple in its design.

The Healthcare Blue Book aims to do for healthcare what the Kelley Blue Book did for used car shopping: allow you to compare prices before you buy. The Healthcare Blue Book identifies the prices of more than 200 medical procedures—from surgeries to imaging tests. So says the product’s vendor, Priority Health.

Priority Healthis a non-profit health plan in Michigan. Their Blue Book uses Priority Health’s contracted provider fees to figure out what Priority calls a “fair price” for healthcare services. The product evaluates prices throughout Michigan based on whether they are fair, more expensive than fair, or below the fair benchmark.

Like it or not, we’re all consumers of healthcare. The older we get, the more we consume. One of the reasons we’ve let healthcare get so expensive is that we’re not savvy shoppers.  There’s no reason shopping for healthcare should be any different than shopping for a car.

Until the late 1950s buying a new car was a mystery to most people. A buyer had no clue what the car cost to make, what the manufacturer’s markup was, and how much the dealer made. A buyer was just guessing when he negotiated with the dealer, who held all the cards.

In 1958 Oklahoma Senator Mike Monroneysponsored the Automobile Information Disclosure Act of 1958.  The law required car manufacturers to post the suggested retail price of the car on the vehicle. It was a start. Consumers could at least know what the manufacturer thought the car was worth. Salesmen in bad suits and loud ties could no long lard up the price with secret dealer markups.

Eight years later a publisher named Edmund’s began publishing quarterly guides with car purchasing information: list price, markup, cost of options and other data. If you knew about Edmund’s you could negotiate a fairer price because the dealer was no longer the only one at the table who knew what things actually cost.

In the mid-1990s, Edmund’s took its information to the Internet and forever changed the way people buy and sell new cars. Now both parties—buyer and seller—had the same data. Car buying became less about pulling the wool over buyers’ eyes and more about working professionally with buyers to find the right car at the right price.

Products like the Healthcare Blue Book have the potential to shine a light in the dark recesses of healthcare—the Finance Department—much like Sen. Monroney and Edmund’s did for buying a new car.

In a technology-driven world we often want the Big Solution. The sexiest, most technical, most awe-inspiring solution to a problem. It’s that way with healthcare. I don’t think that health information exchanges, ACA, ACOs, HIEs or any other alphabet soup solutions will necessarily get us to the level of healthcare reform we need.

I think that small, incremental, common-sense steps like establishing pricing transparency with products like the Healthcare Blue Book, restoring cuts to tax-free savings for medical expenses, making insurance truly portable from job to job, medical liability reform, health savings accounts, and selling insurance across state lines to increase competition have to be part of any solution.

As I tell my kids, take care of the little things. If you do that the big things usually take care of themselves.

Last week 13 attorneys general sent a letterto Health and Human Services Secretary Kathleen Sebelius expressing privacy concerns over the Affordable Care Act. 

Their specific concern is the enrollment procedures for the health insurance exchanges (HIX) being planned under the law. The AGs told the Secretary that the people who take your personal health information when you enroll in an HIX aren’t adequately trained in how to handle it.

I should add that the 13 AGs represent states that have declined to establish their own state exchanges.

Last month DHHS released a final rule requiring so-called navigatorsto have at least 30 hours of training in handling your private information. But the problem, say the AGs, is that DHHS isn’t requiring background or criminal checks on the people who handle your most private information. 

In fact, the standards for people who sell you health insurance are tougher than the security standards for these navigators, according to the complaint. The AGs point out that on a state level these health insurance sellers and brokers, unlike the "navigators" who handle the same private information, are subject to strict exam-based licensing. 

The DHHS response? The navigators have been trained enough and that’s that.

Call me crazy, but this strikes me as a cavalier response to the AGs.  I think the screws on our personal privacy are getting a little loose. Where I live, even Little League® coaches have to undergo criminal background checks. Teachers have to undergo three security clearances—a sex offender registry check, a state police background check and an FBI fingerprint check. All to pass out the white paste and crayons.

Why shouldn’t I know that that the person who is looking at my most intimate personal information—my health—isn’t a criminal who is going to sell my information? It’s pretty simple. I know that sometimes this privacy thing gets out of hand. It’s a relative thing. I don’t really care who knows what movie I took in last Friday night at the multiplex. But I might care a lot about who knows my diagnosis following a college weekend in Tijuana 20 years ago.

I think most people would agree that we need to update how we delivery and pay for healthcare. But the polls have consistently shown consumer opposition to the Affordable Care Act. Blowing off legal concerns about security is a bad way to convince already skeptical consumers that the ACA is will be a change for the better.

THE HILL’s Healthwatchblog recently referred to the July 2 delay in the Affordable Care Act’s employer mandate as “stunning.” I agree. But the delay in the employer mandate, a key linchpin of the law, is only the latest in a long line of gaffesin the law’s history.

Pundits will disagree on how important the employer-mandate delay is in terms of implementing the law. But I’m more interested in the public relations aspect of these missteps and what they say about the law’s future. So here are what I consider the Top Five PR blunders to date in the ACA’s short history.

Blunder No. 5: The one year delay in the implementation of the ACA employer mandate. The law’s supporters play down the importance of the employer mandate. But if you’re trying to achieve near-universal healthcare coverage, this is the place where you can insure the most lives. So you lose public credibility by minimizing your failure to deliver.

Second, the administration announced the delay in a mid-level bureaucrat’s blogshortly before the long Fourth of July holiday. But this only gave  the impression that the administration had something to hide. 

Third, Democrat supporters of the law played right into the hands of Republicans who chargedthat the delay was intended only to help Democrat incumbents in next year’s mid-term elections avoid questions on the unpopular law’s implementation, which is expected by everyone to be messy. Republicans have complained about the mandate for years. A better play would have been to co-op some of them to at least give the move a veneer of bi-partisanship. 

So the focus once again has become the politics of healthcare, rather than the benefits of healthcare. That's not where the law needs to be at this point.

Blunder No. 4: 1099 reporting. The law’s detractors, of which there are many, have claimed that the ACA will require an enormous bureaucracy that will spew out red tape by the mile. So the law’s 1099 reporting requirement just validated that opinion. 

The thought of businesses having to file a 1099 for every single, inconsequential transaction over $600 was a bridge too far for even the law’s supporters, let alone the business lobby. A bi-partisan death squad killed it in Congress, but not before the image of the ACA was cast as a huge, overreaaching monster.

Blunder No. 3: The CLASS Act. The ACA was intended to include a program for long-term care, known by its acronym, CLASS. Given the rapidly graying of America this was an important component.

But two problems arose. The first was the fact the bill’s supporters, through creative accounting, claimed that the expense of caring for millions of aging baby boomers would somehow mystically contribute to deficit reduction. The second was that from the beginning budget analysts said CLASS was not financially viable.  Congress repealed the CLASS Act last year.

This was a golden opportunity missed by the administration. It should have been able to score points for calling out Congress on a bill that budget analysts said would never work, and for pulling the plug on it. Instead, by sticking too long to phantasmagorical claims of deficit reduction that everyone knew were impossible, they helped foster skepticism of the law as a whole.

Blunder No. 2: ObamaCare for Congress. During the Congressional debate over the ACA, the law’s opponents threw down the gauntlet: If this is such a good idea, then Congressshould give up its own “solid gold” insurance coverage in favor of what at the time was beginning to be called “ObamaCare.” This, by the way, included Congressional staffers. Eventually Democrats accepted a Republican amendment to the bill mandating that Congress and its staffers use ACA-compliant plans.  But by dithering over the issue, the bill’s supporters created an indelible impression in the public that health insurance in this country was going to remain an Upstairs-Downstairs affair.

Second, by failing to commit immediately to ACA coverage for their own families and employees, Congress raised doubts in the mind of the public on the value of the product. It would be like seeing the CEO of an American car company, show up at work in a BMW.

Blunder No. 1: Waivers. Perhaps no blunder on the part of the ACA’s supporter was bigger than giving certain organizations passes on key ACA requirements. Let’s just say from the outset that government regulators grant waivers from all sorts of rules all the time. Not just healthcare. Nothing new there.

But in the case of the ACA the velocity of the waivers was breathtaking. The Department of Health and Human Services has approved over 1,200 waivers alone from one requirement: the elimination of annual caps on benefits.

It also hasn’t helped that many of the waivers were granted to organizations like the United Federation of Teachers, which has supported the administration and the ACA.  Again, the administration lost an opportunity to demonstrate that by exercising flexibility in administering the law it was being reasonable. Instead, the public was left with the impression that the administration was rewarding its friends for their support of the ACA. 

So where does this leave us? Supporters of the ACA look at the law and see the realization of an 80-year old dream: equal access to healthcare for all, lower cost and better quality outcomes.

 But because of these gaffes others see a law that will result only in a massive bureaucracy. A law whose supporters haven’t told the whole story. A law whose goals are outlandish and will never be accomplished. A law whose enforcement will be uneven at best and unfair at worst. 

You can’t fault ACA proponents for believing in the cause of healthcare reform. But when your focus changes from writing, passing and administering law to thinking you’re doing the Lord’s work, you run into trouble. The danger is in believing that the value and benefit of what you’re doing is self-evident, and that any rational person should share your belief. 

But in a diverse pluralistic society that’s rarely the case. You’ve got to build people’s trust in you and your product—in this case the ACA. That's the value of public relations. Until the bill's supporters understand this, the ACA will remain a political, rather than a healthcare, issue. 

This week we commemorate the 150^th anniversary of the Battle of Gettysburg. That turning point of the American Civil War pitted friend against friend, brother against brother, state against state. Perhaps it’s fitting at this time that we revisit another more recent battle that pitted American against American—the battle over the future of healthcare.

Wherever you came down on the Affordable Care Act of 2010, either in favor of the law or against it, is irrelevant now. It’s a round that’s been fired. You can’t get it back in the casing. Now is the time for the law’s supporters and opponents to deal with the implementation, which will be messy. Just this week the government announced a one-year reprieve for large businesses to comply with the law’s mandatory insurance requirements.

So, there are five things consumers need to know about health care going forward.

First, in six months the policies sold by “insurance exchanges,” the crown jewel of the law, begin taking effect. That means if you’re not covered by insurance through an employer, the Medicaid program or Medicare, you’ll need to buy health insurance or pay a penalty. The exchange in your state is a likely place to start looking.

Second, in this new world of health insurance, no good deed goes unpunished. So if you’re a healthy adult who’s taken care of himself all these years, you’ll probably pay more than you have been paying for insurance. A lot more.

The third thing you need to know about health insurance is that the law now mandates guaranteed issue of policies. This means, like the announcer on late-night cable TV says, you can’t be turned down. Regardless of your health condition you’ll be issued a policy.

If you’ve got a pre-existing condition, in all probability that policy will cost less than what you have been paying on the open market. But how can the insurance carriers do that? How do they offset the risk that you present to them? Simple. 

And that’s the fourth thing you need to know about the new world of health insurance under the ACA. The premiums of healthy insureds will be going up to subsidize the risk presented by the less healthy policy-holders.  In essence, if you’re a healthy non-smoker in your 20s or 30s you’ll be paying to cover the risk presented by other, less healthy, policy holders.

So who wins and who loses under this new system? Clearly, the winners are those individuals who have trouble getting affordable insurance now or who have altogether been priced out of the market because of their health conditions. The losers are those healthy, demographically benign individuals who will see their rates go up.

For example, in one analysis, a 40-year-old nonsmoker in Virginia today could obtain a high-deductible ($5,000) plan, which would cover half his medical costs for about $60 per month. By comparison, the least expensive plan available through the exchange system will cost him nearly $200 per month.

Unknown at this point is how many healthy individuals will resist seeing their premiums more than triple going forward. In order for the exchanges to function they’ll need as many nonsmoking vegans, joggers and yoga enthusiasts as they can get. If they bail out of the insurance market and just decide to pay the penalty for not carrying insurance, the actuarial tables get really sideways really fast.

So the fifth thing you need to know about the new healthcare law is your options. If you’re that healthy, middle-aged individual, you need to develop a plan now to anticipate the changes coming next year. Compare insurance quotes—to each other and to what you’re paying now. Examine what your liability would be if you “ran bare”—without coverage. Know now what changes might be in store for your current policy.

Guaranteed issue is an attractive concept and papers over a lot of the flaws in our current healthcare system. But the cold, hard reality is that someone has to pay for it. And like everything else that seems too good to be true, that person is you, the consumer. 

When it comes to health insurance many consumers apparently have the same cavalier attitude that they have about their own medical care.

A recent survey for online broker InsuranceQuotes.compolled over 1, 000 adult consumers about their knowledge of insurance and the Affordable Care Act. Among the findings:

Worse than that, nearly two-thirds of respondents say the new law will result in more, not less, expensive healthcare. Fewer than half said the law would result in an improvement in the health of Americans.

The law’s proponents say that the survey results prove that consumers are misinformed about the new health law.  I disagree. Especially when a search of the term “Affordable Care Act” leads you directly to a variety of the government’s own sites, including the White House.

The only thing easier than finding information on the ACA is blaming the law’s opponents for survey results like these. Ten percent uninformed about the law I could see. Twenty percent. But when you’re looking at two thirds of the people the law was intended to help unsure and apparently unconcerned about whether they’ll take advantage of the ACA’s benefits, I don’t think you can pin it on cable TV or insurance companies.

I think if the survey proves anything it proves that no matter how much government might like to help people, some people don’t want the help. Think about it: How much have we as a nation, through our taxes, insurance rates and cost of goods purchased, paid for wellness programs? Smoking cessation advertising and classes? Gym memberships? The results? Conditions like obesity, diabetes and heart disease are at still at epidemic levels. And still you have consumers, including children, sitting on their butts for hours at a time, watching TV, chowing down a bag of Fritos and washing them down with a liter of their favorite sugary drink.

Let’s face it. Consumers themselves shoulder a lot of the blame for the nation’s health crisis. Congress and the president engineer a law to re-shape what by year 2021 will be 20% of the economy, and you ask those people the law was intended to help if they’re going to take advantage of it and the answer is a shake of the double chins and a puzzled “I dunno.”

Call it misinformed or uninformed; it’s the same thing. You live in this country for four years of screaming 105 decibel debates over the ACA and you still don’t know whether you’re going to buy insurance, or if you’re even eligible for it? That’s the real problem with the ACA. Being uninformed and unsure about the law goes hand in hand with bad lifestyle choices, overeating, not taking your meds, or not getting checkups.

The fact is that too many consumers are divorced from their own health care.

They’re divorced from the responsibility of keeping themselves healthy and figuring a way to pay for it so the rest of us don’t have to.

That’s the real problem with the ACA. And until you solve that, until you make people responsible for their own well-being, you’re going to continue to have this rancorous and now pointless debate. 

In the seemingly endless war over the Affordable Care Act, President Obama was able to claim a significant victory last Friday during what amounted to a campaign stop in California. The President chose the occasion to tout California as a model of the new healthcare law’s effectiveness.

The President has chosen to portray the continuing unpopularity of the ACA as the result of misunderstanding and misinformationon the part of the law’s detractors. And he may be right. Even for healthcare professionals this is a tough bill to figure out. So, when California’s healthcare exchange announced that the individual coverage plans to be offered next year by the exchange would be cheaper by up to 30% than comparable private sector plans today, it was time to celebrate.

But not so fast. The Lobster Shift wouldn’t be the Lobster Shift if it didn’t take a contrarian look at things (See our January 10, 2013 post). And if there is anything in this world that requires a skeptical look, it’s healthcare insurance.

Upon further review, it now looks like the optimistic projections of insurance offered at 2% to 29% below current markets was a case of California Dreamin’. Here’s why:

The California exchange regulators were comparing apples to oranges. They chose to compare the projected exchange rates to California’s current small-business market, where the heavy hand of state regulators has already distorted the market to the point where the exchange rates look good by comparison.

A more accurate comparisonwould have been comparing the exchange’s individual insurance plans with today’s individual plan market, which in California is more lightly regulated than the small-business market, and as a result functions fairly well.

If you compare apples to apples, or in this case, the current individual market to the individual plans to be offered next year through the state’s ACA exchange, there’s little to celebrate. According to the Wall Street Journal, there are five plans today that are 64% to 117% cheaper than what the state expects to market in the public exchange. That’s hardly worth gassing up Air Force One to fly across the country.

The narrative is now shifting. OK, say the regulators, we goofed. The individual market will be more expensive, but beneficiaries will be getting a lot more benefits. However, the cost-benefit of paying for birth control, fertility coverage and to have his children covered till they’re 26 may escape that 25-year old male whose focus may be restricted to hot cars and weekends at the beach.

The President is probably right about the misunderstanding and misinformation when it comes to the ACA. All the more reason when one side or the other claims victory in the healthcare battle to take a second look at the claim.  

In a “Man Bites Dog” lead, we’re pleased to announce that healthcare spending appears to be declining. As of now.

Earlier this month, the Wall Street Journal editorialized that the growth in health spending has leveled out at about 4% over the last three years. That’s lower than it’s been for 40 years and way down from its mark of 6% to 10% over the last decade.

At first glance it looks like the decline is tied to the continuing weak economy: fewer jobs mean less employer-subsidized health insurance and medical treatment. In fact, according to the Journal, the Kaiser Family Foundation recently estimated that nearly 80% of the health spending slowdown can be attributed to economic conditions.

If that’s the case, then we can expect an explosion in health care costs as the economy improves. Right? Not so fast.

There is also evidence that the change in healthcare spending has been going on for longer than thought and that it may indicate a permanent leveling of cost. If so, this would be contrary to everything we think about healthcare.

In fact, another economic model now shows that the slowdown has been going on for a long time. That it is systemic, durable and, perhaps, permanent. Economist David Cutlerand Nikhil Sagni say that their model shows that the recession of 2007 only accounts for about 45% of the decline in spending. That’s about half of the Kaiser estimate.

Taking it a step further, another model by Michael Chernow of the Harvard Medical School has suggested that the spending decline is the result of market choice and competition, introduced into the healthcare market beginning in the last decade. Investigating changes in the large market insurance business he found that these firms did better than smaller ones controlling cost through the use of higher deductibles and co-pays, as well as innovative program designs. These changes account for 20% of the slowdown, the model suggests.

When patients, rather than a third party, are empowered to make their own spending decisions about healthcare, they tend to be more frugal. Over the long haul this lowers overall costs, the models seem to suggest.

During World War II the War Labor Board determined that wage and price controls did not apply to fringe benefits, including health insurance. Providing health insurance was a way employers could retain workers—by raising their overall standard of living without fattening the pay envelop.  In today’s healthcare market there are those who suggest that large companies can reverse the effect of the Board’s wartime decision by plowing money saved by these new high deductible/co-pay models into workers’ paychecks. What would be nice would be a study to validate whether this theory is true.

Which brings us back to today’s current healthcare morass. The Affordable Care Act outlaws most of the types of plan innovation that seem responsible for the slowdown in health spending. For example, the law’s arcane rules outlaw what the government considers to be excessive cost-sharing with beneficiaries.  There go the higher deductibles and co-pays.

Cutler estimates that entitlement spending in healthcare will be about three-quarters of a trillion dollars lower over the next decade if the current slowdown in spending continues. But that doesn’t seem possible under the current ACA rules.

Look for costs to start rising again as the ACA kicks in in 2014. The government will mitigate this effect on consumers by injecting money to inflate the healthcare system. But that money will come out of the left pocket of consumers and go back into their right pocket as a subsidy. The resulting loss in price stability will be greater than the entitlement gain.

After being told that the Affordable Care Act would increase access to health care, Americans are waking up this week to find that’s not necessarily the case. As companies try to comply with the healthcare mandate and still preserve their margins and the jobs of their workers, those with high numbers of low-skill workers are turning to what the Wall Street Journal calls “bare-bones health plans.” Employers fitting this profile can get by with offering preventive care and little else and still avoid the law’s penalties.

These plans defy the predictions that the ACA would result in more coverage for more people. Instead, these so-called “skinny plans” provide minimal coverage. If you’re covered by one of these plans and you need an X-ray, prenatal care or surgery, you may be out of luck.

The law requires that employers with 50 or more workers have to provide health insurance or pay a $2,000 penalty per employer. Up till now this has generally been interpreted as meaning a full range of benefits. But apparently this requirement applies to those plans sold to small businesses and individuals. These are the two groups that typically have had the most difficulty obtaining reasonably priced insurance.

The feds say that these skinny plans appear to answer the mail with respect to larger companies that employ lots of low-wage workers. With typical American ingenuity a cottage industry may be developing around the need for these stripped down plans, which allow employers to comply with the law but not at a cost that would cost jobs. When the ACA bill was passed by Congress, accompanied by emotional speeches from its supporters, I don’t think this is what they had in mind.

The ACA is another example of what can go wrong when you try to carve things like technology or social policy into federal legislation. You may not end up with what you thought you were going to have. More importantly, while the law ossifies on the books, technology, policy and business practices change, creating a law that can obsolesce before anyone realizes it (Hello, Alternative Minimum Tax).

Look for the bill’s supporters to bob for another bite at the apple and close what they see as a loophole in the law’s application. But with the House controlled by Republicans this time around, don’t look for ACA II anytime soon. Lawmakers who try to out think and out pace a free market are most often on a fool’s errand.