Kavita Patel, MD, fellow at the Engelberg Center for Health Care Reform at the Brookings Institution in Washington noted in testimony there are a number of reform efforts in the ACA that have transformed the delivery system and could decrease overall spending.She mentioned experiments with accountable care organizations and bundled payments, along with penalties for hospital readmissions and incentives for transitions in care, as examples.
While it would be too much to say that the ACA has had no effect on spending, in taking as much credit as it is for the slowdown, the administration is overreaching in a way that could backfire. A recent WSJ piece lays out a much more complex reality. It notes that experts attribute three-fourths of the slowdown to reduced consumption of medical services, especially doctors and drugs, and that this reduction is traceable to the recession. Previous studies have found tech advances like big data playing an important role as well.Figuring out the causes of the slowdown is important, because knowing them allows us to figure out if it will be temporary or (for the foreseeable future) permanent. Misattributing it to the ACA means that if the pace of spending picks back up as the economy recovers, President Obama will once again be caught making promises about the ACA that he can’t keep.In a time when the public is already deeply distrustful of the ACA, when delays are increasing the taxpayer cost of the law, and when the influx of the newly insured is sure to raise costs, over-promising on the ability of the ACA to tamp down spending seems like a bad strategy.