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Obama and the ACA's Rocky Implementation

Posted by John McDonough  April 30, 2013 07:39 PM

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Today, President Obama addressed the controversies over implementation of the Affordable Care Act. You can read his complete remarks here, and here is his summation:

"And -- and the last point I'll make, even if we do everything perfectly, there'll still be, you know, glitches and bumps, and there'll be stories that can be written that says, oh, look, this thing's, you know, not working the way it's supposed to, and this happened and that happened. And that's pretty much true of every government program that's ever been set up.

"But if we stay with it and we understand what our long-term objective is, which is making sure that in a country as wealthy as ours, nobody should go bankrupt if they get sick and that we would rather have people getting regular checkups than going to the emergency room because they don't have health care -- if -- if we keep that in mind, then we're going to be able to drive down costs, we're going to be able to improve efficiencies in the system, we're going to be able to see people benefit from better health care, and that will save the country money as a whole over the long term."

His comments were measured and necessary. Necessary because as the crucial implementation phase draws closer -- enrollment opens in October for coverage that begins on 1/1/2014 -- many folks who oppose the law are upping their game after twin losses in the U.S. Supreme Court and the November 2012 elections.  Some folks who are supportive of the law are getting nervous, particularly U.S. Senate Finance Committee Chair Sen. Max Baucus (D-MT) who worried in a recent hearing about an implementation "train wreck.

More disquieting news came today from the monthly Kaiser Health Policy tracking survey.  By a 37 to 40 margin, Americans view the ACA unfavorably, with 23% undecided. Most eye-popping, 42% of Americans either believe the ACA is no longer law or are unsure. And yet, by a 58 to 31% margin, Americans opposed defunding the law, and even more, 50% want to see Medicaid expanded to cover more of the uninsured while 41% prefer to leave Medicaid as is. The truth is, Americans are just confused, as the slide below shows:


No surprise here, I agree with President Obama. Back in 2005 and 2006, Americans were confused and upset about the Bush Administration's implementation of the new Medicare Part D prescription drug benefit. It took several years for the opposition to die down. Implementation of the ACA is far more complicated and challenging than Part D ever was, and we should expect the same.

It is worth keeping in mind -- the most current estimate of the Congressional Budget Office last July is that 29 million uninsured Americans will get coverage through the ACA. That's less than 10% of all 310 million Americans, meaning more than 90% of Americans will see no substantive change except for better and more reliable benefits in their health insurance coverage, just like in Massachusetts.

As Ezra Klein has noted, Republicans continue to do anything and everything they can do to thwart ACA implementation, and then complain loudly about how poorly implementation is going.

Yes, ACA implementation will be rocky, at times messy, and controversial. And we will get through it, and the nation will be -- and already is -- a better place because of it.

This blog is not written or edited by or the Boston Globe.
The author is solely responsible for the content.

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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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