First fruits of PPACA

Some of the first significant elements of the Patient Protection and Affordable Care Act (PPACA) go into effect today, and a number of articles provide details of the changes. (Kaiser Health News has a good roundup.) Among the most significant: the ability for children to remain on parents' policies up to the age of 26, and the ban on annual and lifetime caps on payments. Down the road some other popular provisions will come into play including a ban on medical underwriting (which means sicker people pay more) and a ban on excluding people due to pre-existing conditions.When reform passed my expectation was that there would be grousing for a while but that as popular provisions kicked in health care reform would become more popular, if not by the mid-term elections then at least by 2012. There appears to be a lot of popular momentum against PPACA right now, fed by Republicans, tea partiers, and --to some extent-- by health plans that are trying to blame big premium increases on PPACA.Opponents appear hellbent on repeal and may get their way, at least in part, depending on how the elections turn out.But once the public learns about what repeal means they won't be all that happy, because the provisions described above are likely to prove popular. It will be hard to argue for a return to the days when people are denied coverage or pay more due to pre-existing conditions, or when people find their premiums skyrocketing or coverage dropped once they get sick.Opponents know they need to act fast to knock out health reform before its benefits are widely felt. They need a big win in November to make that happen, which is why the upcoming elections are going to be fought so hard.