Regarded as one of the world's foremost health care economists, Dr. Gail Wilensky had a clear message last week for a sellout crowd at Oak Hills Country Club: Obamacare is the law of the land now, so don't waste time focusing on overturning or repealing it. That opportunity has come and gone.

Instead, she strongly recommended the health care industry should now concentrate on the nitty gritty of the Affordable Care Act's implementation. Over the next few years, she said, the specifics of exactly how the law will be translated into everyday application will be written and codified in Washington. Those likely to be directly impacted by the new rules and regulations should engage with the rulemaking process soon to have any chance of affecting how the law will be applied.

It's an enormously large piece of legislation, but, despite that, many of the important details about how you actually make it operational haven't yet been written, Wilensky told a room full of many of San Antonio's highest-echelon health care executives. That means implementing legislation needs to get drafted. If you're really interested in affecting change, this is where you pay attention, right now, she added, urging vigilant monitoring of and participation in the development of detailed regulations under the law.

Wilensky is an economist and senior fellow at Project HOPE, an international health foundation. She directed Medicare and Medicaid from 1990 to 1992 and was a senior health and welfare advisor to President George H.W. Bush. She also advised presidents Bill Clinton and George W. Bush on healthcare issues and policy.

She spoke March 28 at the annual meeting of the San Antonio Medical Foundation, which manages the land and other assets of the South Texas Medical Center.

Besides the detailed regulatory language that must now be developed, Wilensky said, the usual pattern in Washington of clean up legislation will soon follow. Bills to fix unintended problems with the original legislation could start winding through Congress as soon as 2014 but certainly no later than 2015, she said.

And that's likely to happen every year for the rest of the decade, she said. This process, too, is an opportunity for the industry to weigh in with its desired changes.

Wilensky said she believes the Affordable Care Act has good and bad points. On the plus side, she noted, it provides health insurance to millions who do not currently have it. In many cases, these are people who might allow what should be manageable health problems to spiral into much more serious problems because they cannot afford care.

The uninsured will ultimately get care when their health problems get bad enough, she said, and society at large will end up paying for it anyway. That has been an expensive problem for hospital systems for years.

One big question regarding the law, Wilensky said, is whether some states will opt out of the expansion of Medicaid, the joint federal/state health care program for poor children and the disabled.

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Health care economist: Obamacare the law of the land; adjust to it