Large employers are steering clear of Republican efforts to repeal the Patient Protection and Affordable Care Act (PPACA). Instead, they are focusing on surgically altering individual Department of Health and Human Services rule-makings where bureaucrat interpretations of broadly worded healthcare reform provisions could negatively affect company health plans this year. To the extent that new Republican chairs of congressional committees hold oversight hearings to shine a light on implementation imbroglios, business groups welcome that attention.

"The way the law has been implemented has been a mixed picture," says Paul Dennett, senior vice president of health care reform at the American Benefits Council. For example, he cites rules denying grandfathered status to plans that made cost-sharing changes after March 2010. Grandfathered plans can ignore some of PPACA's requirements.

Another current hot spot is how regulations define preventive services, which must be provided to plan members without cost sharing in 2011, says Gretchen Young, senior vice president of healthcare policy at the ERISA Industry Committee.

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