Implementation and Enforcement of Health Care Reform — Federal versus State Government

Health care reform lurches forward. The House and Senate have both passed reform bills. How well reform works in practice, however, will depend on one key difference between the two bills that has received far too little attention — how their provisions will be implemented and enforced.The essential frameworks of the House and Senate bills are quite similar: both include health insurance and underwriting reforms, insurance exchanges, subsidies to make insurance affordable, individual mandates, and penalties for large employers who fail to insure their employees. Yet their approaches to oversight and enforcement, and in particular to the respective roles . . .