Note: This is the third in a three-part blog series highlighting the 10th anniversary of the Affordable Care Act (ACA) (see part I of the series here; and part II here). We invite you to visit ACA Now, the most comprehensive and user-friendly online resource summarizing key developments for every provision of the law over the past decade.
Today is the 10th anniversary of the passage of the Affordable Care Act. Ten years ago, the ACA was seen as the most progressive step toward health care reform that the U.S. could politically accomplish. At the time it represented compromise, with several more progressive proposals tabled in order to achieve the ultimate goal of expanding health care coverage. Now, we find ourselves at a similar juncture with an election on the horizon and health care as the top priority for the American voters. Except this time, the current proposals on the table go beyond what we could have envisioned for the ACA.
In 2010, many understood that the ACA was not a cure-all, but a step forward that would need additional attention in the future. Now that the future has arrived, where do we go from here? How do we address the current health care problems of today? The uninsured rate has increased for the first time since the passage of the of the ACA; 50 percent of adults report putting off care due high costs; and 25 percent of Americans struggle to afford their prescription drugs. While the ACA made significant progress towards universal coverage – with an additional 20 million individuals being insured under the law – coverage gaps and affordability remain key concerns.
Is the answer incremental reform built upon the platform of the ACA, or is it a shift to a new system wherein the federal government is the sole insurer for all Americans? The front runners in the 2020 Democratic Presidential primary have positioned themselves at each end of this spectrum, with Former Vice President Joe Biden favoring the public option approach, while Vermont Senator Bernie Sanders stands by his Medicare for All proposal. Moreover, while the debate continues at the federal level, individual states have moved forward in developing their own public option proposals using existing state authorities.
Ten years ago, none of these options seemed politically viable. The public option was left out of the ACA because of lack of support in the Senate, and only a minority of Americans supported a single national health plan. Now, however, support for these two options has surged, with 66 percent of Democrats supporting a public option, and 52 percent supporting Medicare for All. Several congressional hearings have been dedicated to the possibility of a single payer health care system. Industry stakeholder support is also growing, most notably evinced by the American College of Physicians officially endorsing both proposals (though the American Medical Association voted to leave a coalition in response). And what seems to be driving this shift is as mentioned before: While the ACA has made definitive progress, many Americans still remain uninsured.
While the direction of health care reform is heavily dependent on the upcoming election and pending Supreme Court case, it is clear that additional reform is needed. Whether it be a public option, Medicare for All, or something else, we can expect health reform to be central in the coming months and years to come. But what’s important to remember is this: the solution must, and more noteworthy, can now go beyond the current capabilities of the ACA to provide affordability relief and reliable coverage for millions of Americans.
Erin Slifer is Senior Policy & Communications Associate with the Wynne Health Group. She works primarily on pharmaceutical and provider policy issues, and has a keen interest in innovations in payment and care delivery models. You can reach her via email at firstname.lastname@example.org, and can follow her on LinkedIn and Twitter as well.