We’ve come a long way over the six years since Congress began crafting the Affordable Care Act. We’ve traveled from death panels to death spirals, passing through nearly 60 House votes on ways to repeal or gut the law, at least one election defined by it and two Supreme Court challenges to it. But finally, with the Court’s definitively worded ruling in King v Burwell, we may have arrived someplace hopeful: the beginning of a meaningful debate over the law’s role in fixing our broken healthcare system.
There is plenty to debate. The right’s obsessive focus on Obamacare’s repeal has been maddening for many reasons—the dishonesty that has defined its critique, the way it has leveraged disturbing ideas about the president’s legitimacy—but among the most frustrating side effects has been its impact on the urgent work of improving the law. Everyone has been too occupied with arguing over Obamacare’s very existence to truly watchdog its implementation—and its many potential pitfalls. The law is, still, predicated on the idea that healthcare is a consumer product rather than a public good. And even in its most successful manifestation, the Affordable Care Act will by design leave out millions of people who live in this country and, their immigration status notwithstanding, depend upon our health system.
So let’s get back to basics: The United States has the most expensive healthcare system in the world, delivering the least effective results among its would-be peers of wealthy nations. That’s been true for a very long time. One big reason for the system’s colossal failure has been that tens of millions of people only enter it once they are in crisis—meaning they are both more expensive to treat and less likely to have healthy outcomes from that treatment. As the Court’s ruling deftly summarizes, the Affordable Care Act aims to fix this problem by making insurance more cheap, more fair and mandatory. Is it working?
There’s little question the law has worked in its core goal of expanding the number of people who have insurance. The uninsured rate among non-elderly adults began dropping as elements of the law took effect in 2010 and fell off a cliff once it was fully implemented. After years and years of handwringing over steady growth in the ranks of the uninsured, Obamacare turned the clock back. The share of our population without coverage dropped by more than 4 percent last year, a Centers for Disease Control study found, arriving at a lower rate than the CDC has seen since before 1997.
But there remain significant political and regulatory fights if we are to translate this accomplishment into a functioning and equitable healthcare system. Here are three.