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Something about ACA I’m thankful for…

Posted by John McDonough  November 26, 2013 09:20 PM

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So, the website is getting better, much better. That's good news. And stories of Americans finding better and affordable care through the Affordable Care Act are starting to proliferate. Soon, we can expect the media to start ignoring the ACA, until the next reason for panic erupts.

Here's something for which I am thankful:

Thank goodness the rollout of the new coverage/subsidies/website was scheduled for 2013 and not 2011 or 2012!

Over the past three and one half years, many have asked me: why was the fall of 2013/early 2014 the time for implementation as opposed to 2011, 2012, or the fall of 2014. Reasonable question. And here's my answer:

Fall of 2011 -- way too early, too much work to be done, no chance states would be ready to launch their own health insurance exchanges.

Fall of 2012 -- when the ACA was signed in March 2010, 2012 seemed a long time away, and the logical year for implementation. There were concerns about how long it would take states to go through their legislative processes to set up their own exchanges (we believed nearly all states would choose to do so). But two other concerns weighed heavily:

First, the need to keep the total net cost of the ACA -- over ten years -- to under one trillion dollars, something easier to do if there were no expansion in federal fiscal years 2010, 2011, 2012, and 2013; and

Second, the need to avoid potential political flak if the coverage expansion rollout had mishaps, say, on a scale similar to the rollout of the Medicare "Part D" prescription drug program in 2005-06.

So, the rollout was set for 2013. And thank goodness! Can you imagine the political freakout that would have occurred if the rollout debacle were happening in the fall of 2012 or 2014???

I am thankful that Team Obama is getting the infrastructure of the ACA right, however long it takes to get all the way. I am even more thankful this is happening now rather than 12 months before or after now.

Health care justice for Americans is winning.

Happy thanksgiving!

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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