After reading the summary and further researching the case, answer, in a paper of 1,500-1,750 words, the following questions:What is the role of bureaucracy in the implementation of the Affordable Care Act?How does the policy implementation of the Affordable Healthcare Act limit the powers of public administrators?
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On March 23, 2010, President Barack Obama signed the Patient Protection and Af-fordable Care Act
(PPACA) into law. Seven days later he signed a second health care reform bill, the Health Care and
Education Reconciliation Act, into law as well. The PPACA is the largest social service reform in the
United States since the creation of the social security system in the 1930s, dealing with a policy area that
represents somewhere between 15 percent and 20 percent of the U.S. gross national product. The
legislation is hugethe bill is more than 2,400 pages in length. The Obama administration claims that
the law will expand coverage to tens of millions of people who were previously uninsured and the
Congressional Budget Office estimates that the national deficit will be reduced by over $100 billion in
the first ten years and $1.2 trillion in years eleven to twenty. The laws, referred to here as PPACA or
health care reform, include expanding Medicaid eligibility, incentives for employers to provide insurance
to employees, the creation of health exchanges where the uninsured can secure coverage with subsidies for low-income individuals and families, additional exchanges created for small businesses,
insurance provided regardless of pre-existing conditions, mandatory insurance coverage for individuals,
longer periods that pharmaceutical companies can market drugs before generics may be marketed,
support for medical research, and various taxes and fees on high-income individuals, tanning parlors,
and medical and pharmaceutical companies. Hundreds of other provisions of the law regulate all
dimensions of health care. Implementation of this massive, diverse, and complex policy area is no small
task. Although estimates vary, most agree that when done, more than 100 new agen-cies, boards,
commissions, offices, and other entities will be created to implement the bill. Although the precise
number is unknown now, there is little doubt that tens of thousands of new federal employees will be
required. Although many agencies will be involved (e.g., Internal Revenue Service, De-partment of
Labor), the United States Department of Health and Human Services (HHS) is primarily responsible for
implementation and oversight of the PPACA. HHS has announced the creation of several new agencies,
boards, and offices to ful-fill its mandate, including an Office of Consumer Information and Insurance
Over-sight, Office of Insurance Programs, Office of Consumer Information and Insurance Oversight,
Office of Health Insurance Exchanges, Office of Consumer Support, Independent Payment Advisory
Board, Innovation Center, and Patient-Centered Outcomes Research Institute.New agencies with
congressional mandates and new delegations to existing agencies will also mean new regulations.
Indeed, the Internal Revenue Service, De-partment of Labor, and HHS have already promulgated their
first set of regulations.
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