Employers struggling to stay afloat in the flood of guidance on implementing the Patient Protection and Affordable Care Act will find themselves looking both forward and backward this year. Their challenge: to gauge how the PPACA rules issued so far are affecting their plans while at the same time anticipating the changes that lie ahead in 2012, 2014, and even 2018.

"There were a lot of mandate changes and a lot of notices sent out [in 2010] and people were exhausted after doing all that. Some of it was done very quickly - once you got the regulations, sometimes you only had a few weeks to implement. We're finding that people are going back and saying, 'What exactly did we do, are there things we need to do to fine tune and what are the cost implications for what we did?'" says Kathryn Bakich, senior vice president and national health compliance practice leader at Segal.

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