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Americans Support Medicare, Medicaid and ACA Expansions

Posted by John McDonough January 29, 2013 07:57 AM

A major new public opinion survey on the Affordable Care Act, Medicare, Medicaid, and other key health issues (done by the Kaiser Family Foundation, the Robert Wood Johnson Foundation, and the Harvard School of Public Health -- including my colleague Robert Blendon) is chock full of important and compelling findings. Let's look at some:

1. Though Americans continue to have mixed feelings about the ACA, they increasingly support implementation of the law's primary pillars. For example:

-- On the ACA, while 52% agree that opponents of the ACA should continue trying to change the law or stop it, with strong differences between Democrats and Republicans, fully 86% of Americans say that "creating a health insurance exchange or marketplace" is an important or top priority.

-- 65% say that "expanding Medicaid" is a top or important priority. 



Whole Foods’ John Mackey Gets ACA and Health $$ Wrong

Posted by John McDonough January 22, 2013 12:41 PM

I appreciate and patronize Whole Foods (and Stop & Shop) and had no knee-jerk reaction when I heard its CEO John Mackey refer to the Affordable Care Act (ACA/Obamacare) as "fascist." Eye-rolling, perhaps, at another example of over-the-top ACA hyperbole. Mackey quickly apologized for his "poor word choice" and added the below comment:

"I believe that, if the goal is universal health care, our country would be far better served by combining free enterprise capitalism with a strong governmental safety net for our poorest citizens and those with preexisting conditions, helping everyone to be able to buy insurance. This is what Switzerland does and I think we would be much better off copying that system than where we are currently headed in the United States."

So let's talk Switzerland. It is true -- the Swiss system is 100% private with no public health insurance like Medicare or Medicaid at all. But that's not all.  Swiss health insurers, by law, are 100% non-profit -- no profit-making plans at all. (Not quite "free market", huh?)  More than that, Swiss plans are even more tightly regulated than are health insurers in Massachusetts, one of the most heavily regulated health insurance markets in the nation. I used to joke, post MA-health reform and pre-ACA that Massachusetts has drifted out into the Atlantic and was heading toward ... Switzerland!

And how is the Swiss system doing? Here's a recent summary slide from the Commonwealth Fund:


Holes in the ACA: A Damage Assessment

Posted by John McDonough January 14, 2013 05:19 PM

In my experience and memory, just about any major complex law, federal or state, gets revisited and revised repeatedly by the legislative body that created it, especially when that law is health-related. The adjustments may be large, small or in-between; substantive or technical; most often they get noticed by the tiny "attentive publics" and ignored by 99.99% of everyone else.

And so it is with the Affordable Care Act (aka: ACA, Obamacare). Many assume that partisan gridlock on Capitol Hill has blocked Congress from altering the ACA, and they are mistaken. The repeal of the CLASS Act in the new year's "fiscal cliff" tax law, (the ACA's entire Title VIII) led me to consider: how much alteration has already occurred, and how much real damage has been done? I knew there were more than a few items, and I had never seen a list of all of them.

By my count, (and please let me know what I have missed) there have been eight consequential, substantive changes to the ACA since its signing in March 2010.  Seven were done by Congress and one by the U.S. Supreme Court (SCOTUS). I list them in order of consequence, recognizing that many will disagree with my rankings:


CLASS Dismissed – What Happened?

Posted by John McDonough January 7, 2013 10:03 PM

In the new law to avoid the so-called fiscal cliff (the American Taxpayer Relief Act of 2012, ATRA), approved last week, Congress and the President repealed the entire Title VIII of the Affordable Care Act (ACA, Obamacare), arguably the largest change in the national health reform law since it was signed nearly 34 months ago in March 2010. One might assume this repeal involved lots of budget savings -- that would be untrue. Savings = $0.00. So what happened?

Title VIII is called CLASS: Community Living Assistance Services and Supports, and was the personal cause of my Senate boss, the late Senator Edward M. Kennedy, who advocated for its inclusion in the ACA until his very last days in August 2009. What was CLASS?


Health Policy Details in the Fiscal Cliff Deal

Posted by John McDonough January 2, 2013 10:43 PM

In news accounts of yesterday's new tax law approved by Congress to avoid the "fiscal cliff," health care barely got a mention. One might think that the law had nothing to do with health care. Nothing could be further from the truth.

The big issue was Medicare physician payment, and preventing a nearly 30% drop in physician fees because of the 1997 law called the Balanced Budget Act which included a flawed provision called the Sustainable Growth Rate (SGR) that has been causing havoc with Medicare physician payments since 2002. Congress and the President prefer to repeal the whole thing, but can't figure out how to find the $300 billion to do so, so they keep approving short term, one-year "patches."

So the SGR's impact is again delayed for another year, at a cost of $25.2 billion. [Click here to go to the CBO report on the cost of health provisions included in the new law.] There are other provisions that increase spending by small amounts, though most of the other provisions are "pay-fors" to finance the cost of the one-year physician payment fix. There are 29 Medicare and other health related sections in all. Here are some of the big ones:


About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »


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