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Jan 20, 201407:53 AMOpen Mic

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Can the Affordable Care Act still live up to its promise?

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With all the widespread and much-deserved criticism that accompanied the rollout of the federal Health Insurance Marketplace — the primary “storefront” of the Affordable Care Act — it would be easy to throw the baby out with the proverbial bathwater and declare President Obama’s hallmark legislation a complete failure.

But to do so would probably be shortsighted.

Without question the first eight weeks of were the stuff of Murphy’s Law, causing both state and federal officials to change rules, alter deadlines, revise promises, and delay portions of the ACA’s implementation. But for a reform bill intended to drastically change America’s health insurance and health care delivery model for decades to come, it is important for us to take a long-term view of its impact beyond those first eight weeks.

Further, we should be careful about judging the entirety of the Affordable Care Act on sales alone. While it is certainly intended to make health insurance available and affordable for a large chunk of the nation’s estimated 51 million uninsured, regardless of pre-existing medical conditions, the law is actually much more ambitious than that.

It intends to improve our nation’s health. One of the ACA’s most powerful provisions is also one of the least discussed. Dozens of vital preventive services — screenings, tests, vaccinations, and counseling, to name a few — must now be delivered without any co-pay by the patient. These free preventive services are designed to maintain good health, or at the very least to identify medical problems at their earliest stages when treatments are most effective. Over time, preventive care and early detection will combine to improve population health.

It intends to make insurance and care more affordable. There are three primary ways in which the law tries to manage costs for the end consumer:

  1. By establishing limits on out-of-pocket expenses (minimizing the chance that sickness or disease could result in financial ruin).
  2. Even though we have not seen a substantial number of “young invincibles” access products through the federal marketplace yet, premium tax credits and cost-sharing reductions certainly do encourage younger, healthier people to buy health insurance. This will eventually help balance the insurance risk pool and lower the per-patient cost of care. As care costs decrease, so will premiums.
  3. Today, many of the uninsured are getting medical care in the most expensive way possible — through hospital emergency rooms. As we acclimate the newly insured to the more efficient and cost-effective care delivery model — that is, through a primary care physician — ER usage should decline.

Of course, there is the added cost control inherent in greater competition between insurance companies. As the Health Insurance Marketplace attracts more insurers, each designing benefits within the same parameters, premium rates could stabilize.

It intends to make benefits more uniform. In addition to preventive services, the ACA provides that each health plan must offer a minimum set of 10 “essential health benefits.” Not only do these EHBs create a richer and more comprehensive level of coverage, they also eliminate “bad policies” that only create the illusion of coverage. There is a potential side benefit as well: the EHBs, combined with the uniform metal tiers of insurance plans (Platinum, Gold, Silver, Bronze), could serve to raise the insurance IQ of our population, allowing Americans to better manage their chosen benefit.


Old to new | New to old
Jan 21, 2014 01:23 pm
 Posted by  Anonymous

It intends, it intends, it intends...

"One of the great mistakes is to judge policies and programs by their intentions rather than their results." -Milton Friedman

Jan 22, 2014 01:35 pm
 Posted by  John

Megan McArdle has a pretty convincing case that it won't, in Bloomberg this week, entitled "Resolved: Obamacare Is Now Beyond Rescue".

Love the Friedman quote, Anonymous.

Jan 23, 2014 09:00 am
 Posted by  Greggor2

I agree that the judgment of the merits of this bill should not hinge on how many people signed up last month. It hasn’t.
Unless a person has been under a rock for the last 5 years (or relies on the mainstream media to satisfy their appetite for news & info) there’s been plenty written and now even more documented. No need to have last month’s sign-up figures have anything to do with how we judge the merits of the ACA. I know of no one who does.
Just a thought but, would there be any chance that the bill could be judged on how it was represented to the American people? That should be easy since it was debated a lengthy time before being passed….it was covered widely on C-span…. etc, etc. We’re fortunate in the case of the ACA because even some less significant pieces of legislation are written in the backrooms of Washington, even before the election of a new president, and then thousands of pages appear magically. In these bad examples there’s no time for adequate media coverage. Sometimes they end up being passed in the dead of night, even using D.C. tricks like reconciliation…and worst of all, these bad examples may even pass without a single bi-partisan vote.
Thank God that didn’t happen here. This is far too important because it touches every American (and every American business). In this case that we can simply refer back to the process….how the ACA was sold (sorry, ‘presented’) to the American people, how it was debated in the town square, and, it’s final form hammered into sound public policy.
On the other hand, if that information were not available I’m sure we could figure out what was ‘intended’ back in 2009.

Jan 23, 2014 03:58 pm
 Posted by  Anonymous

The more important question might be: what impact does the law have on most Americans come November elections? And then, is that impact enough to make a difference that will affect voters at the polls?

I think this legislation could be a complete "whiff", but if voters are no longer engaged, and want to hear about something else from candidates, say, jobs, then we're through pondering. All hand-wringing will be out of vogue. And this law will not change for a long time because no legislator will want to touch it again.

If the electorate is outraged and motivated, then might see further reform down the road. But no one will run to make this happen. It's proven to be a toxic topic, and no one seems

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