Effects of the ACA 5 Years After Implementation

The panelists discuss the Affordable Care Act (ACA) and what the effect of the legislation has been in the 5 years since it was passed. Austin Frakt, PhD, started off the conversation by highlighting issues of coverage and access. He noted that while the rate of insurance coverage has increased across the board, there is huge variation as a result of incomplete Medicaid expansion and incomplete engagement with the health insurance marketplace. As a result, the country hasn’t reached what might be considered the “right rate” of insurance coverage.

“We’re not really having a conversation about what to do next about that, because still haven’t gotten over, ‘Is the ACA communism or is it a great thing’ kind of debate,” Dr Frakt said.

In the aftermath of the ACA, there has been a lot of talk about how many people are insured and not enough on what level of insurance they have, Margaret E. O’Kane said. While she is a proponent of value-based insurance design, she recognizes that it’s easier to simply set a high deductible. Unfortunately, doing so puts barriers to appropriate care, she said.

Leah Binder raised the issue of the impact the ACA has had on employers. During the first 2 years after implementation, employers were simply trying to figure out how to comply with the law. But while they are frustrated by emerging regulations that change the rules on them, they have been interested in the movement toward value that the ACA has brought.

Although the ACA has been driving toward payment and delivery system reforms that should impact quality, and Matt Salo believes they will eventually lead to better quality, he doesn’t know if that has been demonstrated just yet. But Binder and O’Kane pointed out some measures, such as the complication rate in diabetes care and safety in hospitals, that show dramatic improvements are already taking place.

Looking forward with the ACA, even though it has beaten 2 legal challenges at the Supreme Court level, there is a new lawsuit making its way through the courts that questions the payments the administrator is giving insurers even though Congress never appropriated funds.