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.
In summary, while I have concerns, I remain optimistic that the ACA will be a major success. Nevertheless, there is much work to be done and I hope that more of us can join together to ensure the best outcome. Please let me know if you are willing to help with the ACA.
