Upholding the Affordable Care Act

Upholding the Affordable Care Act (ACA) is just another milestone in a long and tortuous road toward better health care in the United States. The critics will remain, and the proponents will struggle with making the changes work. But at least now we can move on to the practical medical matters most Americans care deeply about.

Like most big pieces of legislation that have been passed, this law is complicated and messy because it tries to minimize damages to those who already have protections while adding new ones. That’s why the mandate’s critics recognize that some people will have to pay more—but not that the ACA makes it possible for a lot more people with pre-existing conditions to get insurance.

The ACA has also been attacked as unfairly harming Medicare. In practice, the law seeks savings in payment levels. Care providers should find these bearable since they'll benefit from ACA coverage expansions elsewhere and they'll find ways to provide care more efficiently. Meanwhile, under the ACA, seniors get more preventive services and the gap—the so-called donut hole—in prescription coverage shrinks. (Wholesale repeal of the law might have ended both.)

So far, many supporters of reform have been frustrated by the administration’s timidity in applying the new law. For example, defining an essential benefits package has been left to the states, even though many are awaiting further guidance on other key ACA elements and are hard pressed to meet deadlines for getting exchanges up and running and giving insurers enough time to develop good plans.

Another credible criticism is that the administration isn’t emphasizing long-term cost savings in health care. The irony here is that the same folks who criticize the reform for not doing enough to control costs are beating this drum now. Politics aside, the reality principle here is that it’s too soon for anyone to know whether key ACA features—such as reforming the delivery of care, changing the way we pay for care, and chucking failed experiments while replicating successful ones—reduce spending or not. Here our health care system needs imagination and patience in equal measure as we try new things and go with what works best.

Sorely needed now is a shift in the debate to more constructive examination of what needs fixing. Why resurrect the bogus argument about “death panels” or waste time in calling this socialized medicine when there is so much work to be done to improve our health care system and results? The biggest challenges going forward are to tackle our complex system piece by piece, help the public understand this new legislation, and discredit those who raise straw men purely to scare people and delay legitimate change.

Marilyn Moon is a an Institute Fellow at AIR. Dr. Moon has also served as a public trustee for the Social Security and Medicare trust funds.