One Year Anniversary of ACA

I guess if you are a health policy blogger, you must commemorate the one year anniversary of the Affordable Care Act (ACA) becoming law with some reflective, pithy comments.  Austin wisely predicts lots of political bluster with the hardest part yet to come. A variety of predictions via Kaiser Health News.

I would put the bottom line like this.  We desperately need a political agreement about how/whether we will seek to expand insurance coverage toward a goal of covering everyone so that we can then shift our energy toward the really hard work of trying to address health care costs.  If we could (ever) settle the politics about coverage then we could begin muddle through on costs with some general agreement about a coverage framework; it will take both political parties to address costs. We are currently locked into a situation in which opponents of the ACA say that the hard parts of the new law will be impossible to implement, but they act as if the hard parts of their ideas will be easy.

This is my suggestion of a what a compromise might have look like (a mixture of substance and political wins for both sides). There is no hope of getting anywhere near universal coverage without a mandate of some sort (individual, employer, expand government insurance are the three choices).  If you are opposed to all of these, then I don’t see how you can move toward covering everyone.  It is a legitimate position to say you don’t think it is a priority to move toward universal coverage, and it would be useful if the opponents of the ACA made it clear if that is their position.  This would greatly clarify matters for the 2012 election which could then be litigated, at least in part, on clear differences in the area of health reform.  If this is not the position of ACA opponents, then they should provide the details of the plan that proves that I am wrong and there is a way to move toward universal coverage while controlling costs without a mandate of some sort. Or a plan to focus on costs while not expanding insurance coverage.

So far, opponents to the ACA have gotten away with simply stating what they are against, and have not really made clear what they are for. I wonder if they will be able to get away with that all the way to the 2012 election?

About Don Taylor
Professor of Public Policy at Duke University (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute). I am one of the founding faculty of the Margolis Center for Health Policy, and currently serve as Chair of Duke's University Priorities Committee (UPC). My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

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