On the ACA, we’re arguing about not only the expansion of Medicaid, the employer and individual mandates, and the Cadillac tax, but also the proper roles of the federal government, the states, employers, individuals, and other players in the US health care system … about US fiscal, tax, health care, economic, and social policies. And about our values, and whether the ACA reflects them, or doesn’t.
Many different policy questions deserve consideration:
- How does the ACA affect the balance between federal and state responsibilities?
- How does the ACA affect the federal deficit now and in the long term? How does it affect long-term health care costs?
- How might we restructure current federal and state health care expenditures via Medicare, Medicaid, the tax laws, and other programs to improve their effectiveness? What about expenditures by employers, individuals, and their families, and other stakeholders?
- How does the ACA affect the competitiveness of certain companies or the US? Will it level the playing field for individuals who work for employers that provide health coverage and individuals who don’t? How about the cost of labor? Worker job lock and mobility?
- How does the ACA affect the US middle class, economic inequality, and economic opportunity?
- How does the ACA affect access to and delivery of health care services? Health care coverage? Does it promote health care quality? Does it reduce waste? Does it improve individual health management and wellness? Does it alter the roles of health care providers and those paying for health care? Does it affect how we pay for health care services?
- How does the ACA affect the health care plan marketplace — employer-based health coverage, the individual and group markets, new groups of individuals, private health care exchanges?
Of course, the ACA is not a single payer system, and it’s not Medicare for all … although specific aspects may reflect those approaches. On the other hand, the ACA clearly limits some of the flexibility that providers, insurers, employers, individuals, and other stakeholders previously had.
Is this intervention in the market justified by important policy goals? Should we take governmental steps like those in the ACA to extend minimum levels of health care coverage to more Americans? When is it preferable to prioritize the community or group in the health care area? Does extending health coverage (particularly with government subsidies) support or undercut incentives to work or, more philosophically, human rights, individual freedom, or human dignity?
Of course, “yes” and “no” are both reasonable answers to most if not all of the questions above — the ACA is not just one thing or the other. Over the next several years, as we consider changes to the ACA — the status quo is not a viable option — it’s essential to examine the empirical evidence, fairly describe the implications and pros and cons, recognize the tradeoffs, and accept that neither embracing nor repealing today’s ACA is the best solution. And to acknowledge that sometimes we adopt laws for good reasons not well measured by financial yardsticks.
Mercer has assembled a panel of experts to reflect on key health care reform developments and share their expectations for the future. Harry Conaway is a Senior Partner and Leader of Mercer’s Washington Resource Group.