April 1, 2015

REPUBLICANS WILL REFORM IT, NOT REPEAL IT:

THE HEALTH CARE DISCONNECT (RONALD BROWNSTEIN, 3/27/15, National Journal)

This hostility to the ACA has become impervious to contrary evidence. Like all major federal legislation, the law has exhibited flaws and produced unintended consequences. But, by any reasonable accounting, it is contributing to an array of positive health care trends.

Since Obama signed the law, the number of Americans lacking health insurance has declined by 16.4 million. That's fewer than advocates hoped, but it has still reduced the share of uninsured Americans by more than one-third. In a 2014 survey by the nonpartisan Commonwealth Fund, three-fourths of the newly insured said they were satisfied with their coverage. Fourteen million fewer adults in 2014 than 2012 said they deferred needed care because they couldn't afford it, the survey found.

From 2011 to 2013, federal figures show, per capita health expenditures grew at the slowest rate ever recorded; although cost growth ticked up in 2014, largely because of rising drug expenses, the long-term trends remain promising. "It's hard to be wildly optimistic," says Len Nichols, director of George Mason University's Center for Health Policy Research and Ethics, "but I do think we've bent the [cost] curve, and there is momentum in our direction." Premiums for employer-provided insurance rose nearly 40 percent less from 2011 to 2014 than they had in the previous three years. In the ACA exchanges, premiums increased minimally in year two, largely because 25 percent more insurers participated. The exchange markets "show significant stability," says Caroline Pearson, senior vice president of consulting firm Avalere Health.

Total cost estimates for implementing the ACA have plummeted. At the same time, quality is improving: Studies have found steady declines in both hospital-acquired illnesses and hospital readmissions since the law's passage. In states that expanded Medicaid, doctors are diagnosing more diabetes cases early, too--ensuring cost-savings and better health later.

The law isn't solely responsible for these trends. But with provisions that range from penalizing hospitals for substandard care to rewarding coordination between doctors, it has accelerated a critical shift toward linking physician compensation to the standard--not just the volume--of care. The law's initial experiences offer promise that expanding access, restraining costs, and improving quality can be complementary, even reinforcing, goals.

In a rational political system, Americans would be debating how to improve the law and smooth its inevitable bumps (like overly restrictive coverage networks). Instead, we remain trapped in a theoretical debate increasingly disconnected from the law's actual impact.

Posted by at April 1, 2015 4:32 PM
  

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