Challenges, questions loom over health law implementation

Health law implementation faces tough scrutiny as the "fiscal cliff" looms, even as it remains the law of the land. Republicans are leading a charge to change the law and are calling for greater specifics about its implementation.

National Journal: 'Obamacare' Is The Law Of The Land, But 3 Enormous Challenges Loom
How quickly the politics of health care has changed. Just over a month ago, the country was debating whether President Obama's health reform law, aka "Obamacare," should be saved or scrapped. Now, with the president's re-election, that's all settled, and regulators, states, employers, and health care providers are rushing to get ready for a transformed system that is coming in 2014. This involves several challenging tasks. Industry is readying itself for hundreds of pages of regulations, insurance companies for new products and some 7 million new customers in the first year, states for an IT infrastructure unlike anything they have seen. Employers are facing a raft of new requirements, including an obligation to cover all of their workers or pay fines for not doing so (Sanger-Katz, 12/14).

CBS News: As 'Fiscal Cliff' Looms, Health Reform Questions Linger
Washington lawmakers this month are squarely focused on deficit reduction as they attempt to scramble off the so-called "fiscal cliff." All the while, however, the government is proceeding with the costly and ambitious rollout of the Affordable Care Act. Key components of President Obama's health care law won't go into effect for about another year, but federal and state lawmakers are obligated to start building up those health care systems now. Many Republicans, however, argue the Obama administration hasn't said with certainty what the programs will ultimately cost or how they'll be governed. Democrats largely chalk up the complaints to the latest chapter in Republican-led obstruction against the Affordable Care Act, pointing to Democratic-led states that are making progress implementing the law (Condon, 12/14).

Politico: Tom Price: Time To Move On Obamacare Alternatives
A Republican doctor on the House Ways and Means Committee encouraged his colleagues Thursday to produce meaningful legislation to replace the Affordable Care Act in the next session of Congress. … Asked for specifics, Price said the exchange subsidies could "easily be morphed into a defined contribution model to allow for true flexibility," enabling patients to choose high-deductible catastrophic plans, for example. "Those kinds of things would be available where the current law doesn't allow them," he said (Cheney, 12/13).

The law could also affect access to care for illegal immigrants --

The Associated Press/Washington Post: Health Care Overhaul Could Reduce Treatment Options For Nation's 11 Million Illegal Immigrants
But in states with large illegal immigrant populations, the math may not work, especially if lawmakers don't expand Medicaid, the joint state-federal health program for the poor and disabled. When the reform has been fully implemented, illegal immigrants will make up the nation's second-largest population of uninsured, or about 25 percent (12/14).