I do not have any profound insights about the ACA at this juncture. I will just share my thoughts for what they are worth.
I first want to note, as previously stated, the ACA accomplished major changes from the start. For instance, as of 2011:
- young adults under 26 could enroll in their parent’s insurance policy
- children could no longer be excluded for pre-existing conditions.
- the Medicare prescription drug doughnut hole was reduced
- preventive care services were expanded under Medicare.
Now to the major phase of the ACA, the expansion of the Medicaid program and the creation of the health insurance exchanges or marketplaces, which started this past October. I share the frustrations of many with the myriad problems of the Federal and State marketplaces. The computer problems have been very troubling and frustrating. It appears that the worst of the problems are over but we are not home free as problems continue. It is also noted that similar programs, like the Medicare prescription drug program, also had start-up problems. Whether or not we reach the goals for this first year, many millions will have enrolled in the private insurance and Medicaid plans and their costs will be significantly reduced. Costs will not have been reduced for all, but apparently for most. In subsequent years, many many more will enroll in these programs.
Like others, I am optimistic that many additional states will embrace the Medicaid expansions in the coming years.
As others have noted, the rate of inflation for health care costs has significantly declined. It is not clear whether the ACA has been a factor but there is a reasonable possibility that it has. And there are additional provisions in the law that will continue to contribute to reductions in the cost curve.
I have a few regrets, which are:
- that I could not get adequate attention to Steve Morse’s website which is the most comprehensive consumer shopping comparison site. I had Zeke Emanuel endorse it in an editorial, Congressional Quarterly and Hearst Newspapers highlight it, and the Capital Region Connector use it, but it is not used widely.
- my efforts to engage a number of organizations to comprehensively mobilize enrollee recruitment efforts at the State level have so far not been very successful
- several of my other suggestions have not had an impact, but a few have.
I am also very pleased that I was able to organize and provide assistance at a number of enrollment fairs, which got some media attention.
To those who say we should have had single payor, my answer is that Baucus and his staff, who were the under-appreciated architects of the ACA, pulled off a most brilliant move. It was the best compromise that could have been achieved given the politics of this country. Many European countries that have national health insurance do not have single payor systems either. Perhaps somewhere down the road, single payor will be achievable but not in the near future. Keep in mind, Presidents for 100 years have tried to enact reform without success. Obama deserves credit for having learned the lessons from the Clintons by letting Congress take the lead and only being a cheerleader and lobbyist with some key input.