Gail Wilensky is a health economist and a fellow at Project HOPE, an international health foundation. From 1990 to 1992, she directed the Medicare and Medicaid programs and also served in the White House as a senior health and welfare adviser to President GHW Bush. She's overseen several changes from a health care perspective and testifies regularly before Congress. Wilensky spoke with DOTmed News about the implementation challenges ahead for the law.

DMN: It seems like each week, there is some news about a little-noticed ruling in the Affordable Care Act or a loophole. For example, the other day, the New York Times reported that the law grants a one-year grace period to some health care insurers allowing them to set higher limits or no limit at all on some costs. Do you think these kinds of revelations will continue and what might be the consequence?

GW: I think that we are going to continue to see things like that. This next year is going to have lots of bumps in the road. It's not at all clear what is going to happen when Oct. 1 comes. And some of the protocols in the federal government exchanges, which may have not been tested as much as they should have, go online live. Or if it turns out that there are higher than predicted call volumes that come in — people don't know if it will be in tens of thousands or hundreds of thousands — whether the systems will be able to handle whatever volumes come or whether these various state exchanges will be able to function. But having said that, I like to remind people: don't take comfort that the Affordable Care Act is likely to go away because it's not. It's just likely to be a rocky bumpy road for the first year. This is way more complicated than anything I can remember getting involved with in my professional lifetime. I mean, it's way more complicated than the Part D prescription drug coverage benefit that was added in 2006.
There are many features of this that are only going to be understood in terms of how serious they are once they've been tried, but that doesn't mean the law is going away. It just means it will take some time to get this right. I like to remind some of my Republican friends of that.

DMN: For the most part, premiums on various state health insurance plans that will be sold in the new health exchange marketplace have been lower than expected. Do you think this can be sustained?

GW: I think it's nice that the premiums are lower than people thought they might be, but of course, you have to be careful. You have to look at what you're buying for some of those premiums, which may have, for an example, a substantial deductible or copay. So it might not be a premium for a very full benefit plan.

Healthcare Act