Does Affordable Care Act get a passing grade so far?

By Katherine Michalets - Freeman Staff

March 17, 2015

WAUWATOSA — Nearly five years since President Barack Obama signed the Affordable Care Act into law, health organizations and industries connected to them are evaluating how the first years have gone and what the major effects have been.

During a panel discussion Monday at the Medical College of Wisconsin, Froedtert Health President and CEO Cathy Jacobson said the ACA has spurred a considerable amount of experimentation, especially in terms of Medicare and dealing with reimbursement levels.

“Medicare is so pervasive. It’s the single largest payer of health care expenditures for any provider in the United States. Whenever they do something a different way in terms of reimbursement, that’s when it impacts the commercial market and that’s what has been going on for the past five years,” she said.

“Just about every major payer, in fact every major payer across the United States and most major health care systems, are involved in commercial arrangements that are taking on those experiments in some way, shape or form. So while that may be a consequence of the law, it is not written into the law, but it has been one of the biggest changes that we have seen in the last five years.”

When the experiments occur in the commercial market, Jacobson said there is more opportunity tweaking it and trying to get it to match the needs of different communities of people compared to when it’s done by Medicare and tends to be a more “cookie cutter” approach.

“There has been a lot of experimentation and it truly has started to change the way that health care providers are viewing their future,” she said. “I have never seen the health care system voluntarily moving toward a different way as much as I have seen in last five years.”

WEA Trust President and CEO Mark Moody said the dire predictions that came out in advance of the Affordable Care Act never came to fruition.

“Health care costs have not skyrocketed as some had predicted. Employers have not abandoned their sponsored plans in droves as was predicted. Insurance companies haven’t gone bankrupt,” Moody said.

In fact, Moody said there have been many beneficial effects, such as 11.7 million people covered under state and federal exchanges, many of whom would not have had health insurance otherwise. In addition, Moody said, there have been millions of young adults who have obtained health care coverage under their parents’ plans until the age of 27.

Moody also highlighted that the ACA eliminated the doughnut hole in Medicare Plan B, which he said was a relief for many seniors, as well as high-risk insurance programs being eliminated in Wisconsin.

Confusing to small employers

While insurance companies and larger corporations were more equipped to deal with the changes, it left small employers unsettled, Moody said.

“Small employers were really baffled. There was so much coming at them so quickly and they didn’t have the resources, the expertise within their own organizations to cope with that,” he said, adding the Obama administration did give them a one-year reprieve.

When assessing the ACA, University of Wisconsin-Milwaukee health care economist Owen Thompson said the real question is did the law achieve its main purpose which was to expand health care coverage in the U.S.

“The good chunk of it was supposed to come from Medicaid expansions and I think that has proceeded more or less as planned,” Thompson said. “Of course the Supreme Court made it optional for the states and the states, notably Texas and Florida, in terms of individuals chose not to so far.”

Overall, Thompson said health care exchanges are functioning as they were intended to and health care premiums have remained fairly consistent.

“As far as the narrow goals of the law go, in my opinion it’s more or less working OK,” he said.

Thompson added he’d give the ACA a grade of C, according to what the grade meant in 1980.