Two goals of the Affordable Care Act (ACA) are to provide more Americans with health insurance and lower the overall cost of healthcare.
What it’s actually wrought so far hasn’t always aligned with the original vision. Healthcare cost growth has slowed, but experts disagree as to how much that is due to the effects of the ACA or the sluggishness of the economy.
On the consumer side, the use of the healthcare.gov website as the primary vehicle for enrolling people in health plans backfired initially when the technology failed.
In spite of that misstep, 20 million Americans have gained health insurance coverage as a result of the ACA, according to The Commonwealth Fund. That includes eight million who purchased new healthcare plans through the insurance marketplace--outpacing the Congressional Budget Office’s (CBO’s) estimate of six million young adults who gained coverage under their parents’ policies.
The number also includes adults and children eligible for Medicaid or the Children’s Health Insurance Program, and individuals buying policies directly from insurers. The CBO estimates that by 2017 the ACA will result in 26 million fewer Americans being uninsured.
The ACA also set minimum standards for all health insurance policies, including coverage for preventive services and immunizations. In addition, it prohibits insurers from dropping members for any reason other than fraud and from rejecting anyone due to pre-existing conditions.
Critics of the legislation, including most Republicans, point to the penalty for not obtaining health coverage, the growth of narrow networks, new taxes, cyber threats, increased bureaucracy, and potentially higher premiums as reasons for repeal.
To gain perspective on whether the ACA is achieving its goals,
Managed Healthcare Executive recently asked four key stakeholders to share their thoughts on what the legislation has accomplished thus far and its potential future impact.
Brian Klepper, Ph.D., is chief executive officer of the National Business Coalition on Health, a national, non-profit membership organization of purchaser-led healthcare coalitions.
Klepper credits the law with helping to solve America’s uninsurance problem, but says the bill was distorted by excessive lobbying by the health industry--“$1.2 billion in 2009, the year the law was formulated.”
“The industry successfully focused on two major goals. It achieved a 10% enhancement of coverage at public expense, increasing funding for their services. To my mind, this was a good thing because America’s uninsurance problem has been and continues to be a national disgrace,” Klepper says.
But that same lobbying “really did a number on any meaningful ability to control costs,” he adds. “The result is that current cost patterns that are so excessive haven’t changed much, and there’s not much prospect for them to change, particularly until we move away from fee-for-service and go onto some form of risk. And things have gone very slowly in that direction.”