President Obama’s signing of sweeping reform legislation largely ends the year-long battle for a national health care overhaul. However, a series of lower-profile fixes and spats has taken its place, as officials grapple with translating the new law into workable programs and try to close unexpected loopholes.

Some fixes reflect the difference between the law as written and how it will be put into practice. For instance, Obama administration officials expected the legislation would immediately compel insurers to cover children with pre-existing conditions. However, several insurers argued that the legislation’s ambiguous language meant they could ignore the coverage requirement until a broader ban on denying coverage for people with pre-existing conditions takes effect in 2014.

HHS Secretary Kathleen Sebelius on March 29 dispatched a letter to the head of the insurers’ trade association, America’s Health Insurance Plans, signaling that insurers should immediately provide coverage to such children and that she would issue new regulations to ensure the change holds. AHIP has said insurers will comply with Sebelius’ instructions.

Other trade associations also are seeking to influence how the legislation is implemented. The U.S. Chamber of Commerce is lobbying legislators to write new language that minimizes the bill’s effect on businesses’ tax deductions, while the American Medical Association is trying to steer comparative effectiveness research and the creation of a new panel that will advise on Medicare cuts.

On a state level, some consumer advocates are pushing for officials to expand upon or fill in perceived gaps in the legislation. For example, the new law would allow adult children ages 25 and younger beginning in September to remain on their parents’ health plans, which potentially affects 3.8 million young adults in California. Given the state’s high uninsured rate — and that young adults between 19 and 29 are the fastest-growing age group at risk of being uninsured — some young adults are calling on California to extend eligibility like New Jersey, where single adult dependents up to age 31 are allowed to remain on their parents’ coverage.

Meanwhile, California legislators continue to push for increased regulation of health plan premiums. Federal lawmakers had proposed such a fix, which was supported by President Obama, but Democrats could not add to the overhaul via the budget reconciliation process. To fill that gap in California, AB 2578, which passed the State Assembly Health Committee last week, would require insurers to receive state approval for premium increases exceeding 7% a year. The bill’s backers say the measure is necessary to address behavior by insurers like Anthem Blue Cross of California, which is expected to hike premiums by up to 39% next year.

Reactions to Reform

• Former Massachusetts Gov. Mitt Romney (R) on Monday lauded his state’s health care law, which provides near universal insurance coverage for its residents, while highlighting the “crucial distinctions” between his plan and the national health reform law, the Boston Globe reports. During a speech at Iowa State University, Romney said, “Overall, ours is a model that works,” adding, “We solved our problem at the state level. Like it or not, it was a state solution. Why is it that President Obama is stepping in and saying ‘one size fits all’?” (Issenberg, Boston Globe, 3/30).
• French President Nicolas Sarkozy on Monday voiced his support for the new health reform law during a speech at Columbia University in New York. Sarkozy said, “Welcome to the club of states who don’t turn their back on the sick and the poor.” Sarkozy and his wife are scheduled to have dinner with Obama on Tuesday (Charlton/Dobnik, AP/Philadelphia Inquirer, 3/30).
• A Democratic National Committee official last week said that the group this week will begin airing radio and television in 35 congressional districts designed to tout the benefits of the new health reform legislation, according to Politico‘s “Ben Smith” blog. The ads also would thank Democrats for voting for the measure and critique Republican members who opposed it. The official said the budget for the ad campaign is in the “significant seven figures” (Smith, “Ben Smith,” Politico, 3/23).
• Tea party activists have launched a 23-state bus tour in an attempt to protest the health reform law, USA Today reports. The tour began on March 27 in Nevada, with a stopover in Senate Majority Leader Harry Reid‘s (D-Nev.) hometown of Searchlight. The activists will proceed to congressional districts where lawmakers voted for the health care overhaul. The tour will end on April 15 to highlight “how much money the federal government is taking from the people,” according to Republican strategist Sal Russo. Former Alaska Gov. Sarah Palin, the Republican vice presidential candidate in 2008, will headline one of the tour’s 44 scheduled rallies (Dorell, USA Today, 3/25).