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Just How Big Is the Health Care Reform Law?

May 19, 2010

True to the cliche, it makes a pretty good doorstop:

Whenever big legislation that changes the tax code is passed, the nice folks at CCH send MONEYa bound copy of the new law, along with their explanation of how it will work. The Patient Protection and Affordable Care Act is long enough to require two volumes, one for the law itself (plus a committee report) and another for CCH's explanation.

The length of this bill became an argument against it. So for context, I've put a third volume in the picture: On the bottom is CCH's copy (with explanations) of the 2008 bill that created the TARP. I used to also have copies of the volumes on each of the past two major tax-cut bills; if memory serves, they were about the same size as the TARP book. So there you go: The PPACA is really long and complicated, even for federal legislation. But federal legislation is routinely long and complicated.

How is a citizen supposed to make an informed decision about a bill this long? Well, you could rely on a journalist's analysis, like the one I wrote with my colleagues Amanda Gengler and Michelle Andrews. But if you want something more unfiltered, go to a good plain-language summary, like this one from the Kaiser Family Foundation. I've read the law — to the extent that this is possible for a layman (more on that in a second) — and as far as I can tell, the folks at KFF play it perfectly straight. They haven't left anything important out, and it takes a lot less time to read the KFF's version than the actual law.

With any piece of legislation, reading the bill itself is usually as helpful in understanding the law as reading computer code is to learning how to use an iPhone app. Okay, that's overstating it; the law is written in English, more or less. But like computer code, legislation is really just a detailed set of instructions, in this case for a machine made of lawyers and administrators. A lot of stuff you'd just take for granted (like, say, what a health insurance plan is) has to be spelled out explicitly, whereas a lot of the stuff you really want to know is dispatched with a quick reference to another section in the legislation or in another law. The results can be confusing. Reading the bill, I was shocked to discover that the "public option" government-run insurance plan, which had been dropped from the health care reform package, was actually still in the final legislation. I knew I couldn't possibly have a scoop here — someone at The Washington Post, the Republican caucus or Joe Lieberman's office would surely have noticed — but it sure was baffling. That section of the bill, it turns out, is dropped from the law by a single line that shows up about 2000 pages later.

The lesson: You can't read most modern legislation in raw form without a trustworthy guide. But there are a lot of good people who do that kind of guidance for a living, and the web has made them easier to find.

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