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Federal Agencies To Iron Out Health Care Details

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Federal Agencies To Iron Out Health Care Details

Health Care

Federal Agencies To Iron Out Health Care Details

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ROBERT SIEGEL, host:

The new health care law is more than 2,400 pages long. Even so, it is short on details including exactly how many of its provisions will work and how theyll be enforced.

NPR's Wendy Kaufman reports on the government agencies that now have to fill in the gaps.

WENDY KAUFMAN: It may seem hard to believe, but even with all those pages of text the new law doesnt go into all the nitty-gritty details. For example, many of the terms used in the measure aren't defined. And exactly how individuals would prove they health insurance isnt specified.

It's an approach to lawmaking that William Galston of the Brookings Institution has seen for decades.

Dr. WILLIAM GALSTON (Senior Fellow, Brookings Institution): Since the New Deal, the legislative style has been to leave a fair amount of actual detail undetermined by the text of the legislation itself.

KAUFMAN: It's all but impossible, the former Clinton administration official says, for Congress to spell everything out.

Dr. GALSTON: And that's where the regulatory process comes in.

KAUFMAN: Federal agencies, such as Health and Human Services and the IRS, will begin to draft proposed rules. Jim Miller, who headed the Budget Office under President Reagan, says the agencies will use the text and the legislative history to guide them.

Mr. JIM MILLER (Former Director, Congressional Budget Office): So it's not a challenge of the sort where you're opening a box and you've never seen what's inside. You know generally what needs to be done.

KAUFMAN: But the scope of this measure is extremely broad. Coordinating regulations across government agencies will be challenging. And dont, says Miller...

Mr. MILLER: Be surprised if the number of pages of the regulations dwarf this 2,000-plus pages that are needed to spell out the act itself.

WEISS: The law is being challenged. But if it stands as written, it will affect employers, insurance companies and individuals. Beginning in 2014, individuals will have to prove they have health insurance. So how would they do that?

Some of the law's critics raise the specter of swarms of IRS agents knocking on individuals' doors demanding to see their insurance cards. But University of Pennsylvania Law School Professor Cary Coglianese sees a different model.

Professor CARY COGLIANESE (Director, Penn Program on Regulation, University of Pennsylvania Law School): Your employer sends you a W-2 form that shows what wages you've earned and what taxes you have provided. At the same time, they are also reporting that to the IRS. And the IRS makes decisions about who to audit based upon whether what's being reported to the government matches what individuals are actually filing with their tax returns.

WEISS: The regulatory expert believes individuals would simply staple an additional form to their tax return to show they have insurance. Their insurance provider or employer would also send IRS documentation.

But the law professor adds it's hard to overstate the massive amount of information that will be generated by this law, and hard to overstate the challenges of processing all the data.

Professor COGLIANESE: What makes this very difficult is not the conceptual complexity, but rather the fact that it's applying to hundreds of millions of people.

KAUFMAN: Still, most of the enforcement effort is years away, and a lot could happen between now and then that would affect how the law is implemented.

Wendy Kaufman, NPR News.

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