Sunday, December 22, 2013

Was 2013 A Good or a Bad Year for the Affordable Care Act?

Roughly a week left in 2013, and the year end reviews are popping up everywhere. Was it a good year? A bad year? Who knows?

To the more specific question was 2013 a good or bad year for the Affordable Care Act or "Obamacare" as its often referred to, I say it was a very good year.

Some of you may ask how on earth could anyone consider 2013, with its bungled rollout of the exchanges, with its poorly-worded "if you like your plan, you can keep your plan..." not to mention its last second changes exempting certain slices of the population from the individual mandate while forcing most to still carry health insurance, etc. a "very good year?"

I say it was a very good year because, for the most part, the ACA is moving forward toward its goal of decreasing the number of uninsured Americans. Yes, it stumbles at times, looks down-right awful at times, makes no sense at times, but it lives on. Remember the 48 or 49 attempts by Congress (let's give credit where credit's due, the House)? Virtually none of them stood a chance against the majority controlled Senate or Mr. Obama's White House of really getting rid of it. Those votes were symbolic, and played to the base and almost no one else. I'm not sure how big of a bang the last 15 generated compared to the first 15, but hey, Speaker Boehner gets to run the show in the House (wait, did I just type that?) and if he wants to spend the House's time and our money holding these "for show only" votes, who am I to object?

The ACA has problems. Some pretty big ones, in fact. The private insurance market is in chaos, the rollout of the website has been well chronicled and fairly assessed as a rank amateur disaster by many and people seem to dislike Obamacare more than they like it. Far too many states, mostly in the South have (so far) rejected the Medicaid Expansion which leaves many poorer people and families on the outside looking in as far as accessing health insurance coverage.

As long as the ACA is moving, albeit imperfectly, towards full implementation and its goals, its been a pretty good year. Here's my reasoning. Every year that Obamacare continues to draw breath reduces the likelihood that it will be repealed anytime soon by the Republican Party. Had Mitt Romney defeated President Obama and at the same time, the Democrats lost control of the Senate, while the GOP maintained control of the House, the chances are very good the Affordable Care Act would've been shown the door. None of that happened, here we are, two years later and millions of young people are staying on their parents health insurance. Millions are benefiting from the increased access to preventative care services. Millions are benefiting from the expansion of Medicaid in many states, providing some with health insurance for the first time in their lives. Hospitals are well on their way toward re-engineering their operations with a nod toward quality of care and less so fee for service and quantity of care. Even the health insurance companies are mostly behind the ACA. Sure, they probably don't appreciate how President Obama stuck them with some headaches in the individual market over the last six weeks or so, but business models have been over-hauled. Changes in policies, procedures and products have all been planned for and are being implemented at a not insignificant cost to the insurance companies themselves. As Sam Cooke sang years ago, "a change is gonna come..." Is there a rational case anyone can really make to see all of the above done away with or reversed? Seriously?

I don't agree with those pundits who love to cite the website issues or the ensuing slow signup rate as an indication of  the official and permanent failure of Obamacare. We won't know how successful this change will wind up being for a few years. How many young people will sign up? How fast? What other problems that we don't know about yet will surface? What tweaks to the law, that once were routine for the Congress but now are most definitely not, will or won't be put into place? How many and how soon will states who have so far rejected the expansion of Medicaid change course and accept the Fed's offer? We can't know all of these things right now.

Most of the issues you've read about in the last few months will, in the end, get sorted out. Slowly but surely, things will get smoother with the occasional problem needing attention. Whether or not the GOP ever becomes part of the solutions is a question for another day. I suspect Conservatives in moderate or swing states will be the first to try and help out as a show to their constituents of their ability to legislate in a bi-partisan way. Mind you, the risk of these moderates being primaried by Tea Party candidates is real and will happen in many cases. How many elections these challengers from the right will actually win is unknown, but so far, their record is mixed.

While the doom and gloom reporting from some media sources and talk show programs will almost certainly continue. (I just can't conceive of Rush Limbaugh or Sean Hannity reversing their course on this and ever coming out in even a modified support of the ACA.) More and more people will sign up for coverage. More and more people will benefit from having health insurance. More and more people will avoid seeing coverage cancelled or treatments terminated mid-course because of plan limitations. Medical bankruptcy rates should begin to decline. A lot of good is going to be realized across the United States even while we shake our heads at website issues, unintended consequences and a host of other blunders we haven't even thought of yet.

If projections are accurate and the Republicans hold on to the House and walk away with a stronger Minority in the Senate, there's still President Obama and his veto pen just waiting in the West Wing. There is ZERO chance Obama would ever kill his own landmark health care reform.

That brings us to 2016 and another Presidential election. Odds are it will feature Hillary Clinton and somebody (Brian Schweitzer-D Gov. Montana, perhaps?) up against god knows who from the GOP. Regardless, by 2016 there will be another two full years of ACA signups in place. The healthcare cost curve will likely continue to bend in a favorable fashion and the screwups in the individual marketplace from 2013 will seem like ancient history. If the platform for the GOP is going to be a version of "let's take something away from millions of people we'd like to vote for us and still get them to vote for us" well, that'll be quite something to watch.

2013 was a very good year for the Affordable Care Act simply because it suffered no fatal blows. The patient continues to survive and get stronger every day. If the ACA was considered in "critical condition" prior to the Supreme Court vote back in early June of 2012, we might today classify it in "fair condition, but the prognosis is good as the patient is improving."


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