The Law & Health Care Program at the Maryland Carey Law held a pre-election panel titled “The Affordable Care Act: Too Big to Fail?” on October 20. The panel focused on the winners and losers of the Affordable Care Act (ACA) to date and the prospects for the ACA after the Presidential election.
The election is over and the fate of the ACA is unknown, but the panel provided a robust and timely overview of the five-year-old legislation as the new administration and Congress contemplate its future.
The panelists represented diverse constituencies that are affected by the ACA: consumers, Medicaid beneficiaries, health insurers and small business:
Leonardo Cuello, JD
Director, Health Policy, NHeLP
Elizabeth Milito, JD
Senior Executive Counsel, National Federation of Independent Business
Kimberly Robinson, JD
Partner, Funk & Bolton and Executive Director, League of Life and Health Insurers of Maryland
Adjunct Lecturer, Anne Arundel Community College and Board Member, Consumer Health First (former Acting Insurance Commission for the State of Maryland)
Moderator Diane Hoffmann, Jacob A. France Professor of Health Care Law and director of the Law & Health Care Program, opened discussion by asking the panelists what grade they would give the most ambitious overhaul of the nation’s health care system since Medicare was created in 1965.
Leonardo Cuello gave the ACA an A- for its coverage impact. He noted that in 2010, there were 49 million uninsured individuals in the United States and now, in 2016, there are 27 million uninsured – the lowest uninsured rate in US history. He also cited the value of new insurance market protections such as the pre-existing condition protection and the ability of young people to stay on their parents’ insurance until age 26.
Beth Milito gave the ACA the low grade of D+ because it has not been proven to be affordable for small business owners (she did not award an F because coverage has been expanded for the millions as Cuello noted). She stated that business owners rank health insurance as their biggest problem in running their businesses and that the high cost of insurance is the primary reason employers do not offer it to employees.
On behalf of the health insurance industry, Kimberly Robinson gave the ACA a B- because it has expanded individual coverage in the insured market and Medicaid but has not addressed the cost of coverage and cost drivers. She called the ACA a “health insurance reform law” rather than an “affordability law” because it has not addressed the alarming cost of health care and how that impacts the cost of insurance.
Beth Sammis provided a four-part grading rubric for the ACA. In terms of access to comprehensive health insurance coverage, she gave the ACA an A; for uniformity and transparency she gave the ACA an A because the Act has finally created a national benchmark regarding what benefits must be included in a health insurance plan; for shared responsibility, she gave the ACA a B because of the actions of the Supreme Court that unfortunately allowed states to opt out of Medicaid expansion; she gave the ACA a B for affordability (with the promise of an A). She noted that the ACA has not yet solved the affordability problem of health insurance but that various demonstration projects authorized under the Act have the promise of improving affordability in the future. Overall, adding together these components, she gave the ACA a B+.
As to the future of the ACA, panelists noted that it would be very difficult and politically unpalatable to pull insurance coverage away from the newly insured, but possible if Congress so desired. The future of the ACA is a mystery, but the panel provided the audience with a solid understanding of the complex Act that will be useful to health care lawyers and policy makers who are now – or may be – politically active in this area in the future.
The panel was sponsored by the Karen Rothenberg and Jeffrey Seltzer Law & Health Care Program Fund.