Attention baby boomers and senior citizens: Did you know that it’s been four years since the Patient Protection and Affordable Care Act, aka Obamacare was passed? And after all the town hall protests, Tea Party denunciations, Supreme Court challenges, and enrollment gaffes, ACA still remains the law of the land.
How did the states fare in implementing the law’s provisions during that time? Not too badly, according to health policy expert, Deborah Bachrach, who spoke at “The Medicaid Expansion: State Considerations and Strategies” panel discussion held by the Center for the Study of Politics and Government at Cowles Auditorium, August 5, 2014. The states that had begun to expand medical coverage to their constituents as a moral and economic necessity fared best, but already by 2012, those states that had been reluctant to adopt Obamacare “realized that they were in the driver’s seat” so far as how their health care delivery systems could be remodeled.
Some panelists went even further. Former Arkansas Medicaid Director Andy Allison called his state’s conversion of its health care system “a dramatic, natural experiment taking place” that is “not just a political compromise,” but makes “the [medical] marketplace more competitive.” Former Wisconsin Medicaid Director, Brett Davis, agreed, calling the variety of state implementation schemes all part of “the laboratory of experiments that are happening” which comprises the “beauty of America.”
More circumspect as representatives of what moderator Prof. Lawrence Jacobs deemed “the best health care system in the country,” state representative Matt Dean and Minnesota DHS commissioner Lucinda Jesson agreed that “states are the laboratories of democracy,” but more work needs to be done for Minnesota “to move forward,” expand “the private market,” and enable the state’s silo system of small health networks “to be more integrative.”
That more practical work needs to be done there can be no doubt. Only when Arkansas guaranteed by law that primary doctors would get paid for their investment in the state’s new health care system did WalMart become one of the co-payers. Davis agreed that any perception of the new system as “Medicaid expansion” “wouldn’t pass in Wisconsin.” Arkansas’ four-fold increase in younger enrollees showed how expanding the coverage base influences health care results, but as Bachrach observed, “most of the debate ignores the practical.”
ACA’s impact may reflect a “paradigm shift from welfare to coverage,” but the question remains how long until its full implementation is achieved. Jesson pointed out that Medicaid, created by the Social Security Amendments in 1965, took 14 years to be adopted nationally; everyone on Tuesday’s panel felt complete adoption of ACA would be much quicker. Can America’s current and future senior citizens wait for these health care policy wonks to transform the uncommitted states’ coverage plans while more and more multinational corporations move offshore to escape fulfilling their social commitments to their workers? Stay tuned.