By B.L. Wilson
From one day to the next, the state of play changes on efforts to reform health care in the United States.
“The effort to move legislation aimed at repealing the Affordable Care Act recently failed,” Lynn Goldman, dean of the Milken Institute School of Public Health said as she welcomed scholars, experts and GW students Tuesday morning to a discussion on the status of healthcare reform. “But even now there is talk of reviving the push to repeal and replace the law.”
Leading figures who have been involved for decades in trying to improve the health of Americans and access to healthcare participated in three panels tackling the question of the conference title, “The Affordable Care Act: What Comes Next?”
The first panel’s moderator, Sara Rosenbaum, GW professor of health law and policy, first reviewed changes imposed on the insurance market by the ACA.
“The fundamental issue [is] that the market remains open to people regardless of their health condition, both in terms of who can gain access and how insurance products are priced,” Dr. Rosenbaum said.
She said the ACA also set up a system to help families pay for health coverage through subsidies and tax credits, created a marketplace where people can go online and shop for a policy and seek financial assistance, and changed Medicaid coverage for the very poor.
No matter who won the election in November, Georgetown University research Professor Sabrina Corlette said there was general agreement even among ACA’s strongest proponents that it needed improvement. Despite that she said, “The affordable care act insurance marketplace is not imploding. [Insurance companies] are not collapsing.”
Ms. Corlette explained the ACA faced challenges because enrollment was lower than expected since fewer employers dropped insurance plans, the people who did enroll tended to be sicker, many still found premiums too expensive and the eligibility and enrollment process was burdensome, particularly for those applying for Medicaid.
Diane Rowland, the executive vice president of the Kaiser Family Foundation, said the most important thing the ACA did was expand coverage under Medicaid to poor people, including those who were not on welfare and did not have dependent children. She noted that some states took advantage of federal funds that were offered as an incentive, but some objected to providing coverage to adults who were regarded as able bodied.
“One of the challenges is to decide whether as a nation we provide healthcare services to poor people because they are poor and often sick,” Ms. Rowland said, “or whether we are providing it as a part of a cash assistance, welfare mentality.”
Ultimately, the ACA was not so much about healthcare reform as it was about expanding coverage, doing things to make the insurance market more accessible and more fair, according to Gail Wilenski, an economist and senior fellow at Project Hope.
The law has done little to change how healthcare is delivered, she said, which is what Congress might now be debating if there weren’t still an ongoing debate over coverage.
Better delivery systems would allow larger groups of physicians and hospitals to address more social services needs such as food and security, safety and family issues, the so-called social determinants of health.
The main reason the Affordable Care Act remains up for debate is political, said Dean Rosen, a partner at the lobbying firm of Mehlman, Castagnetti, Rosen & Thomas.
“This was a significant piece of social policy that was passed by only one party in 2010. That is not a prescription for durable change on these big, big items,” he said. “Republicans never saw this as something they bought into.”
Republicans split over the legislation often dubbed as Obamacare with many conservatives refusing to go along with anything but repealing it entirely.
Mr. Rosen said there’s now a renewed debate over a conservative proposal that would change the insurance rules and limit the benefits that are covered. “A lot of those things will probably mean that that bill can’t pass the Senate,” he said.
At the same time, President Donald Trump’s Health and Human Services Department could change how the program is administered and cut subsidies to state Medicaid programs.
These developments have created a climate of instability for the Affordable Care Act.
“Just a general uncertainty that the debate has generated could cause a number of insurers to pull away, and say ‘I’ve had enough,’” Ms. Corlette said.
