Blog | Thursday, November 3, 2016

What is next for the Affordable Care Act?


Consider this New York Times article is a “must read”: ”Ailing Obama Health Care Act May Have to Change to Survive“.

Some have claimed great success for the ACA, because 20 million people now have insurance. These proponents emphasize the increased in “insured” and minimize the importance of the continued problems in the individual insurance markets.

Opponents of the ACA emphasize the problems, and ignore the benefits of 20 million more insured citizens.

The truth almost always resides between the polarized ends of our democracy. The act has helped some people (especially those with pre-existing conditions and young adults 26 and younger who can remain on their parents' policies). In states that have adopted the Medicaid expansion, many greatly disadvantaged citizens now have some health insurance.

But many previously insured people are paying more for similar policies. Many people now have limited access to insurance because the insurance companies have lost too much money (or at least that is their excuse).

And both sides will likely admit that the act did nothing to prevent the unbridled greed of the pharmaceutical industry.

The act is too complex and too nuanced at this time. Too many compromises occurred with the insurance industry to get the act passed.

“Even the most ardent proponents of the law would say that it has structural and technical problems that need to be addressed,” she said. “The subsidies were not generous enough. The penalties for not getting insurance were not stiff enough. And we don't have enough young healthy people in the exchanges.”

The next administration will have much to do to address this cumbersome, well-intentioned act. Hopefully, with modifications we can provide coverage for more patients, and coverage that actually works for all patients.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.