The ACA and America’s Health-Care Mess

[marmar]

from Dollars & Sense:


The ACA and America’s Health-Care Mess
BY GERALD FRIEDMAN | January/February 2014 |


While it was enacted in 2010 without a single Republican vote, the Patient Protection and Affordable Care Act (ACA), a.k.a. “Obamacare,” was built model first proposed by the conservative Heritage Foundation in the 1990s and implemented by Republican Governor Mitt Romney in Massachusetts in 2006. The ACA extends the public safety net to more of the working poor but otherwise keeps the private health insurance system intact. Rather than replacing the private system—and far from the “government takeover of health care” its critics claim—it provides subsidies for individuals to buy private health insurance through state-level “exchanges.”

As social policy, the ACA is a qualified failure. The expansion of Medicaid and mandates for individuals to buy subsidized private insurance will expand health insurance to an additional 30 million people. Regulations establishing minimum standards for coverage and barring exclusions for pre-existing conditions will improve coverage for many. On the other hand, by maintaining the existing system of for-profit medicine and private insurance, the ACA does little to rein in out-of-control cost growth while leaving millions without coverage. We can hope that the ACA’s strengths and its failures will soon pave the way for a rational universal system such as single payer health care.

Not Everyone Will Be Insured: While the ACA will provide health insurance to millions of Americans, millions of others will remain uninsured. While over 25 million will gain coverage either through the expansion of Medicaid or by buying subsidized private insurance, somewhat more will remain without coverage. Some are not covered by the act (including undocumented immigrants); others will be excused from the requirement to have insurance because of cost; and others will not comply (see Figure 1).



Problems of People with Insurance Will Remain: Because it builds on the existing private health-insurance system, the ACA does little to reduce access problems for people with health insurance. Those with insurance have dramatically fewer problems accessing health care (including seeing doctors, arranging follow-up visits, and filling prescriptions) than those without. But even insured Americans are twice as likely as citizens of countries with public insurance to have trouble getting care (see Figue 2).



States Rejecting Medicaid Expansion and Exchanges Are Lowering Enrollment: The ACA’s Medicaid expansion would cover everyone with incomes up to 133% of the federal poverty level. Half the states, all with Republican governors, rejected expansion, denying coverage to 7.5 million people. States can establish “health exchanges” for people to choose a health plan and sign up for federal subsidies. Republicans refused to establish exchanges in 34 states. ................(more)

The complete piece is at: http://www.dollarsandsense.org/archives/2014/0114friedman.html

[geek tragedy]

1. Oy.

social policy, the ACA is a qualified failure. The expansion of Medicaid and mandates for individuals to buy subsidized private insurance will expand health insurance to an additional 30 million people. Regulations establishing minimum standards for coverage and barring exclusions for pre-existing conditions will improve coverage for many.[/div]

I would pray that we experience many such failures.

[unblock]

2. yes, and the first rung of a ladder is a failure because you haven't reached the top yet.

the aca was already characterized as an improvement or reform of the system, i don't know anyone who ever thought it would be nirvana. well, maybe the heritage foundation.

[global1]

3. Seems To Me The Blame For The Bulk Of The Shortcomings Of ACA Rests On The Backs Of.....

the Repugs.

They fought ACA from the start. They continue to want to repeal it. They are doing everything possible to throw roadblocks in the way in order to make it fail.

And as stated in the OP - " Half the states, all with Republican governors, rejected expansion, denying coverage to 7.5 million people. States can establish “health exchanges” for people to choose a health plan and sign up for federal subsidies. Republicans refused to establish exchanges in 34 states........"