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Weighing the ACA
The Irrelevance of the Affordable Care Act

One year after its launch, what has the Affordable Care Act achieved? Much less than one might expect, according a feature piece in this week’s Economist. The Economist notes that the ACA’s success has largely been mixed. It has expanded coverage, but mainly though Medicaid and less through the exchanges. Some estimates finding that only 26 percent of shoppers on the exchanges having been previously uninsured. Overall, U.S. health spending did slow dramatically, but this appears to have more to do with the overall economic recession than with the ACA itself, and spending is now picking up. Premiums, according to PwC, are rising by an average of 7 percent across 33 states, with some states seeing hikes as high as 14 percent.

Where the ACA has floundered, however, Americans have succeeded. The Economist examines new services and innovations that are better able to target U.S. health care problems than the ACA is:

Companies are […] slowly lifting the veil from doctors’ costs and quality. Castlight compiles data from employers’ insurance bills, then presents prices to patients. UnitedHealthcare, Aetna, Humana and Kaiser Permanente, four huge insurance and health companies, have given reams of data to an independent research centre. Next year it will launch a website where any insured patient can log in and view quality and cost information for specific doctors and hospitals […]

When patients act like shoppers, health-care providers serve them better. In August the number of retail clinics, which treat patients at malls and outside regular hours, was up 17% over last year, according to Merchant Medicine, a consultancy. Obamacare’s exchanges have inspired new insurance entrepreneurs. Oscar, started by techies in New York, tries to be the patient’s ally, swapping insurers’ usual perplexing drivel for clear information.

Much of this is spot-on; we recommend you read the whole thing. The Economist’s account of solutions is not comprehensive; it leaves out low-hanging fruit like expanding scope of practice for nurse practitioners and making smarter use of telemedicine. But it does highlight a crucial fact: Many of these new developments are entirely unrelated to the ACA. If The Economist is right, much of the most important work of health care reform is still before us, and the ACA has done little to push us further along that road.

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