How to fix the Affordable Care Act's major flaws

Despite surviving five years of skepticism and critical analyses, the Affordable Care Act has several major accomplishments to its name--yet it also suffers from some key drawbacks that policymakers must address, according to two prominent health policy experts.

In an analysis for The Century Foundation, Tim Jost, an emeritus professor at the Washington and Lee University School of Law and a contributing editor at Health Affairs, and Harold Pollack, an affiliate professor in the Biological Sciences Collegiate Division and the Department of Public Health Sciences at the University of Chicago, offer a comprehensive, and critical, review of the ACA. They note that only has the number of uninsured Americans decreased dramatically, but it has also saved hospitals millions of dollars in expenditures. Additionally, public healthcare expenditures have plummeted, and average monthly premiums are becoming more reasonable.

On the other side of the coin, Jost and Pollack's analysis outlines some major issues with ACA, and they also provide some suggestions for how to address them. These include:

  • Expand access to health coverage for moderate-income Americans by fixing the family glitch, reducing complexity to the tax credit program and increasing credits for middle income families
  • Make healthcare affordable by reducing cost-sharing and out-of-pocket limits as well as improving minimum employer coverage requirement
  • Improve Medicaid for low-income Americans by having the federal government permanently assume the entire cost of the Medicaid expansion population
  • Improve the consumer marketplace experience through greater transparency, standardized insurance products and an active guide to help consumers with coverage selection

Earlier this month, the Senate passed a bill to roll back major provisions of ACA, despite the fact that it is certain to face a presidential veto. A full ACA repeal would cost insurers $19 million members and increase the national deficit by as much as $350 billion.

But the biggest problem with ACA does not lie in costs, the analysis states; instead it lies in the lack of regulations to protect low-income Americans. "Perhaps the most serious problem is the inadequacy of the ACA's subsidies and regulatory structures to address the problems of low-income Americans, for whom merely meeting the costs of day-to-day essentials is a continuing challenge," Jost and Pollack write.

To learn more:
- read the Century Foundation analysis

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