How many new government entities, boards, commissions, and organizations does the new health care law create? According to a 42-page report released by the Congressional Research Service (CRS) in July, the correct answer is: Who the heck knows?
The Patient Protection and Affordable Care Act creates a tangle of bureaucracy so thick that the CRS declared it impossible to definitively sort out. "The precise number of new entities that will ultimately be created pursuant to PPACA is currently unknowable," the report says, largely because of the many mechanisms the law uses to create them. In addition to directly creating dozens of new entities, the legislation requires the president, the Department of Health and Human Services, and multiple other organizations to establish new entities of their own. There are other bureaucratic bodies that may or may not be created, contingent on unpredictable outside factors—for example, whether states choose to participate in some of the law's programs, and how many private organizations apply for the law's grants.
When bureaucracies can't be counted, they also can't be accounted for. "It is unclear how the Government Accountability Office (GAO) will be able to independently audit" many of the new entities, the CRS report notes. Nor is it possible to determine how much power many of the new entities will wield. "In many cases," the report says, "it is currently impossible to know how much influence [the new entities] will ultimately have" over the law's implementation.