Medicare history lessons for healthcare reform

Parallels between the Affordable Care Act and Medicare Part D rollouts continue making news, as journalists highlight lessons policymakers may learn from prior national health insurance overhauls. Citing results of a Georgetown University Health Policy Institute study sponsored by the Robert Wood Johnson Foundation (RWJF), an article in The Atlantic made several plan comparisons:

Both the ACA and Part D became law despite political controversy, which jaded initial public opinion of the programs. Consumer confusion followed about what the plans were designed to do and how they'd work. Neither Part D nor the ACA had functional websites when they took effect, The Atlantic reported, and delays resulted before Americans gained reliable website access. And even after improving the websites' reliability, both programs suffered from understaffed call centers and lack of navigator preparedness.

But once Medicare Part D became law, early opponents eventually began working to make prescription drug coverage accessible to beneficiaries. The ACA, however, has received "nothing but [post-implementation] yeoman efforts to sabotage it," The Atlantic reported.

And whereas Part D was a new benefit added to Medicare and run by the federal government, the success of the exchanges relies heavily on state support, as FierceHealthPayer reported.

Part D's target population was easy to identify and reach, while the ACA's target population of uninsured Americans is more diverse, and there's no existing formal mechanism to reach them, the RWJF study had found.  

Eight years after Part D implementation, many of its early implementation troubles have been forgotten, and the public generally considers the program successful. But mainstream media continues serving up saturation coverage of ACA implementation problems, keeping them at the forefront of national attention, The Atlantic reported.

Overall, "past efforts to design and launch a large national health coverage program suggest that the experience will be far from perfect, at least at the outset," the study concluded. "While flaws remain, a program born amidst partisan controversy and launched with considerable wariness has emerged to become a core part of Medicare."                 

For more:
- here's the Atlantic article
- read the RWJF study

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