‘Obamacare’ imperfect but worth fixing
It has become commonplace to play political football with the Affordable Care Act.
While the system isn’t perfect, it’s important to take stock of the advances spurred by the ACA, acknowledge its shortcomings, and work together to construct a system that provides high-quality care and healthier results for all.
Our country spends more money on health care than any other developed nation, yet we are less healthy and live shorter lives than a majority of our international counterparts. The ACA was created to address this paradox — to lower the skyrocketing cost of care, advance health-care quality and improve health outcomes.
The result? After years of rising uninsured rates, millions of Americans have gained access to coverage, sending the nation’s uninsured rate to an alltime low. In Arizona alone, more than 500,000 people who were previously uninsured are now covered under the various insurance options the Affordable Care Act provides.
ACA reforms stretch far beyond the insurance doorway and into the very foundation of the system. Lesserknown pieces of the ACA puzzle, such as a health-care innovation center, are working to improve quality and lower costs. The work is less publicized, in part, because they’re fitting together as planned.
Just recently, Vitalyst released a report and co-hosted a conference on the promise and progress of Accountable Care Organizations in Arizona. The progress and learning we have seen here since 2012 would not have been triggered without the ACA.
Critics of the ACA often point at marketplace challenges as proof that the ACA warrants repeal. History, however, teaches us that although challenges exist, they are neither unique nor insurmountable.
Today, more than 17 million people are insured through Medicare Advantage plans. The program is a wild success, yet in its early years, enrollment plummeted and insurers dropped out. The savior? In 2003, Congress authorized additional subsidies.
The same remedies are available for this Health Insurance Marketplace.
The Centers for Medicare and Medicaid Services recently proposed changes to improve the marketplac.
Programs to assist insurers were included in the ACA, but Congress later refused funding. Congressional reinstatement and extension of these programs would likely help stabilize the marketplace.
Numerous other remedies are available to repair flaws. For example, enrolling more healthy, young people will help to stabilize risk pools. In Arizona, this is being addressed through the Cover Arizona Coalition, in which hundreds of professionals are providing inperson assistance to enroll youth.
The menu of options goes even further. Stronger enforcement of special enrollment periods has already been instituted, and changes could be made to allow insurers to charge slightly more for older enrollees.
Another consideration is to create multistate marketplaces, which might lead to more stable risk pools. We could also strengthen and tighten some of the penalties on the marketplace for those who remain uninsured or postpone enrollment until illness arises.
Regardless, we must acknowledge that fundamental policy and marketplace shifts take time.
Admittedly, the marketplace has its flaws; however, these growing pains do not provide justification for repealing the law. As Frederick Douglass once wrote, “Let me give you a word on the philosophy of reform … if there is no struggle, there is no progress.”
Marcus Johnson is director of state health policy and advocacy for Vitalyst Health Foundation and is dedicated to working with communities on public policy that affords all Arizonans the opportunity to live vibrant, healthy lives. Email him at mjohnson@vitalyst health.org.