It’s a fair bet to say that the Affordable Care Act is here to stay. Many say that it is an intrusion on their privacy, an abridgment of personal freedom and maybe even unconstitutional. There is no doubt that the rollout of the federal health exchange was an absolute disaster.
However, despite the fear mongering, misinformation and political posturing, millions of Americans have signed up on the federal and state health insurance exchanges.
So why the optimism? Because things are getting better. As a model for the ACA, the Massachusetts Health Care Exchange has been operating well for several years. Pre-existing conditions and annual and lifetime health insurance limits are gone. Access to Medicaid has been expanded for low-income families, federal subsidies are available for many new health insurance subscribers and new ways of bundling medical costs through accountable-care organizations are beginning to take hold.
The Affordable Care Act, or an amended version of it, will transform the American health-care system over the long term. The health-care system is extremely complex and will require several years to change how doctors are trained and paid, where we receive health care and how costs for hospitalization, pharmaceuticals and medical equipment will be reduced. It’s a fair bet that as this transformation proceeds, changes in how the ACA manages health care will be needed.
The health-care industry makes up almost $2 trillion, about 18 percent of the U.S. economy. According to several published sources, the annual rate at which health-care costs increases currently exceeds the annual rate of growth of the U.S. Gross Domestic Product. That means that every year, fewer dollars are available for other important investments like education, job creation and highways. This crowding out of worthwhile future investment is unsustainable.