ACA Implementation and Sustainability in Doubt - Health Insurance Marketplaces May Simply Fade Away

by Patrick Riley 16 Oct 2013
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In the hourly give and take between the two houses of Congress as filibusters threaten in the Senate and one political party in the House unravels before the American public, one casualty is almost certain to be recorded, the Patient Protection Affordable Care Act. Signed into law in March of 2010 and then challenged by 26 states before The Supreme Court, the Affordable Care Act has stumbled with the imperative first step of implementation, the launch of health insurance exchanges, which are now referred to as marketplaces, on October 1st.

Much is being learned as to the cause of the many failures and much is being reported by states who elected to run their own exchanges and are documenting success with fully functional online portals to purchase health insurance. Time appeared to be on the side of eventual success. But, recent reports and discovery as to the size of the IT failure at CMs and HHS is painting a dark and gloomy picture, some saying that the functionality is today, only 70% built and will need months to fix.

Meanwhile, in federal legislative process we have learned that a small but entrenched element of the House of Representatives will not move on any government shutdown bill or attempts to avert a default of the U.S. government's ability to borrow money unless the Affordable Care Act is repealed, not delayed or defunded, but repealed. Nothing will deter them from this quest.

This places the sustainability of the exchanges and expansion of Medicaid as well as any of the other provisions of the Affordable Care Act in jeopardy. So, we have come full circle intellectually and find healthcare at the nexus of political beliefs and health policy in America. What once was exuberance over using the legislative process to craft and enact a healthcare law is the same branch of government that serves to dismantle it. Yet, despite this spontaneous expression of political rhetoric our healthcare system is transforming despite the politics that seek to control it.

Could it be that this immediate debacle serves as the impetus to transform and realign healthcare in America despite the political gridlock in Washington? The work of Dr. Donald Berwick at the Institute of Health Improvement and Professor Michael Porter at Harvard are glimmers of hope and commonality of thought and action needed. And as Berwick begins his campaign for Governor of Massachusetts I wonder if politics will envigor him or prove too much for him?

You can follow me on Twitter @Patrick_FrostHC to read more about this debate.

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Comments (1)

By  klara andrian
klara, klara

15 Jun 2017 04:35
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