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Friday, August 5, 2011

How many pages are in the Affordable Care Act?

Most recent posting on ACA legislation and regulations can be found at this address:

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One of the topics I am addressing in my health care series for KSL is how the Affordable Care Act works. In the third article of the series, I touch on the fact that it’s difficult to know exactly how the health care reform legislation works because there is still so much of it that has yet to be written.

The Affordable Care Act on its own was passed and signed into law in March 2010. However, the Secretary of Health and Human Services (HHS) has responsibility for producing associated regulations—and there will be a lot of them. So many, in fact, that former HHS Secretary Michael Leavitt warns that too much power has been invested in one office and that it represents a threat to the “United States’ viability as a global economic leader.”

The implications of his comments are worthy of an article — or a book — of their own, but space limitations being what they are, it was something that I couldn’t address while giving it the attention that it deserves.

What I did look at, however, were some of the issues surrounding the HHS regulations.

Government entities — and relevant private and non-profit organizations — know that they need to make certain adaptations as a result of the Affordable Care Act. In most cases, they even know when. But rarely does any major change broadcast in the legislation come with a full array of details. So governments and businesses are in the sticky situation of having to plan without knowing exactly what they are planning for.

This concept — that it is difficult to know precisely how the legislation works because there is so much of it which has yet to be written — led me to look into just how much is still left unfinished.

My initial findings were startling.
So… how many “pages” are in the Affordable Care Act? In the actual legislation itself, there are just over 2,400. But the legislation is incomplete with the accompanying regulations, most of which have yet to be published.

Paul Bedard, a journalist with U.S. News, reported in April 2011 that the first set of HHS regulations covered six pages of the actual legislation—but resulted in 429 pages of regulations.

I was curious to see what that would mean for the totality of the health care legislation if I applied a ratio of 71.5:1 to the Affordable Care Act.

The result?

More than 170,000 pages.

No, that’s not a typo. It really is a six figure total. By comparison, the U.S. tax code by my calculations is approximately 13,000 pages.

Now, there are admittedly a couple of problems with this projection. First, you really want to be comparing total words and not total pages. Second, I think that it’s highly unlikely that HHS will maintain its current pace in terms of a regulations-to-legislation page ratio.

But the sheer vastness of the number caused me to think that it would make for a helpful illustration of my point.

Future research
If I have time down the road, I might look into this further. A truly valid projection would entail at least two key components:
1.       Compare total words, not total pages.
2.       Look more closely into which sections of the legislation the regulations relate to. In other words, some sections of the legislation may take a few pages to put forth and result in hundreds of pages of regulations, while other sections may take many pages in the legislation and result in only paragraphs of regulations. A more reliable projection would have to take this into account.

 UPDATE: Click here for an update on the length of the Affordable Care Act published Dec. 12, 2013. 


  1. Reading your KSL article and this blog post, has given me alot of insight into this almost "mystical," topic of Health Care reform. Excited to read more.

  2. Thank you for sharing this information.

  3. Since Obama is constantly adding more regulations, exemptions, and other BS into the ACA, were all of these additions since the ACA was voted into law legally added? Shouldn't the law, in its current form, be voted on again? Now we know a lot more of what is in the law, it seems that would be the most reasonable thing to do. (Is Congress still exempt?)

    1. Suzimi1953 - Good questions. They aren't ones that I would anticipate ending up in front of the Supreme Court anytime soon, and I would anticipate the same goes for Congress. The original legislation didn't include any Republican support, and the partisan vitriol continues.

      Nonetheless, as for the question of legality. There's a link in the original article to an Op-Ed in the Washington Post by former HHS Secretary Michael Leavitt. Perhaps this quote from his article will help answer your question:

      "The new powers of the office (HHS Secretary) are symptomatic of a vast expansion of federal control that, in many cases, usurps state authority and limits private-sector autonomy, innovation and profitability.

      "It puts more power than is prudent in the hands of one person, and it is not an answer to our national health-care crisis."