10 ACA-related outcomes I want to see over the next decade

The largest component of the Affordable Care to date will be implemented in less than six weeks. That's when the state exchanges begin offering health plans to consumers and small businesses.

It will be a significant day for healthcare delivery in the United States. Supporters of reform will say it is a milestone, while its opponents will insist it is the beginning of a fiscal apocalypse. Indeed, some members of Congress have suggested withholding funding for the ACA in order to get a budget approved and the debt ceiling lifted, with default on our debt as a potential consequence.

I think proclaiming the ACA as apocalyptic is ludicrous. But nor do I think the ACA will be a success from day one.

There is still a lot of uncertainty about the stability of insurance premiums, whether enough young people will buy insurance, and many other intangibles. Those developments will be closely followed in this space in the months and years to come.

However, there are some changes in healthcare delivery and attitudes about it I would like to see take place over the next decade, and I hope the ACA serves as a catalyst.

Here are my top 10:

1. All 50 states participate in expanded Medicaid. As of 2014, less than half the states are on board, a concern in that it may create a two-tiered healthcare system based on state-by-state ideology. Hopefully, the other states--pressured by continuous lobbying by hospitals and the benefits reaped by their neighbors--will change their minds.

2. Personal bankruptcies tied to medical bills drop by half. Right now, medical expenses are the leading cause of bankruptcy in the U.S. Hopefully, that will change pretty rapidly.

3. The incidence of diabetes drops by 5 percent. As long as we're a country dominated by fast food restaurants on every street corner and junk food ads for every commercial break, we're going to have to have modest goals about curbing this lifestyle disease. But the ACA does include incentives for encouraging exercise and lifestyle choices. Let's hope at least some of them work.

4. Hospitals stop suing their patients over nominal sums. I am hoping enough revenue comes in from Medicaid expansion and the subsidized insureds that filing lawsuits by the truckload will no longer be considered a viable business option.

5. When someone has a minor household mishap or accident, his or her first instinct is to go to urgent care or a pharmacy-based clinic. Hospital emergency rooms actually perform their primary function: Treating seriously ill and injured people.

6. The attitude that providing access to healthcare to those without insurance is immoral no longer has significant support. Instead, we debate with all the other countries as to how to best improve healthcare delivery moving forward.

7. Adults under the age of 30 who think they'll never get sick acknowledge they could be in an accident. And that's why they bought insurance.

8. Our newborn mortality rate is no longer one of the worst among industrialized nations. Maybe it's third or fourth worst instead.

9. No one continues to suggest that all healthcare reform needs is eliminating malpractice lawsuits and allowing insurers to sell across state lines. I'm tired of not only hearing these assertions, but the lackluster effort to debunk them as well.

10. At demonstrations and town hall meetings, a specific sign becomes commonplace.  It bears this slogan: "Leave My Obamacare Alone!"  - Ron (@FierceHealth)

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