Industry leaders weigh in on the state of the ACA

Some of the top healthcare policy experts in the country tackled the current state of the industry and the impact of the Affordable Care Act--both positive and negative--in a series of viewpoints published by the Journal of the American Medical Association.

A wide range of discussion topics included the impact of bundled payments, improving access to care, further emphasis on coordinated care and proposals to replace the ACA. The viewpoints include:

  • One of the masterminds behind the ACA, Ezekiel Emanuel, wrote that although the first several years of the law were problematic, current statistics suggest it has improved access to health coverage, reduced costs and offered a platform for payment changes and delivery reform. Emanuel said "there can never be too much payment change," and the Centers for Medicare & Medicaid Services (CMS) should continue implementing bundled payments while finding ways to reduce drug costs.
  • David Blumenthal, president of The Commonwealth Fund, wrote that bundled risk-sharing payments will help control healthcare costs moving forward. Blumenthal argued that simplifying measurement systems and offering real time data collection will be critical to improving quality within healthcare.
  • Donald Berwick, former administrator of CMS and current president emeritus and senior fellow for the Institute for Healthcare Improvement, attributed the "constant conflict" within healthcare to "an epic collision of two eras with incompatible beliefs." Berwick outlined nine changes necessary for a third era that blends elements of the previous two, pushing for fewer mandatory measurements and incentivized payments, and a greater focus on improvement science.
  • In her viewpoint, Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, argues that after five years under ACA changes, true health reform is just now beginning with a narrower focus on improving existing concerns tied to access to care, fragmentation and data transparency. Lavizzo-Mourey says there needs to be more focus on collaborative efforts between providers to improve care, along with greater emphasis on cost and quality transparency and a push to further reduce the percentage of uninsured individuals through Medicaid expansion and affordable coverage options.
  • Finally, a group of policy analysts from various organizations, including the American Enterprise Institute and Project HOPE, outlined several proposals to replace the ACA and reform government-run healthcare programs. The group recommended expanding private insurance, allowing states to run exchanges, protecting individuals against higher premiums tied to preexisting conditions and encouraging enrollment in health savings accounts.

Last week, the Department of Health and Human Services announced a "historic reduction in the uninsured," indicating that ACA provisions led 20 million people to gain insurance since 2010. In November, a CDC study found that the number of uninsured Americans is at its lowest point, at 9 percent, thanks to state exchanges and Medicaid expansion.

To learn more:
- here's Ezekiel Emanuel's JAMA viewpoint
- read David Blumenthal's viewpoint
- check out Donald Berwick's viewpoint
- see Risa Lavizzo-Mourey's viewpoint
- here's the ACA replacement proposal from 10 policy analysts

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