In commemoration of the 50th anniversary of Martin Luther King Jr.’s passing, the Ford School of Public Policy held a policy talk Wednesday evening on the prospects of the healthcare in the United States and the Affordable Care Act. The talk began with an introduction from Law professor Michael Barr.
Barr highlighted King’s work during his “Poor People’s” campaign, which was designed to draw attention to U.S. poverty in the late 1960s with special attention to poor health care.
“Of all the forms of inequality, injustice in health care is the most shocking and inhumane,” King said at a 1966 Medical Committee for Human Rights convention.
The talk was moderated by Public Policy professor Paula Lantz, who explained the context of the ACA during its creation under President Barack Obama’s administration, as well as current disparagement by President Donald Trump’s administration.
The ACA introduced new restrictions on health care: With few exceptions, citizens were required to obtain health care coverage, allowing states to expand their Medicaid programs to those who previously didn’t qualify. However, critics of the ACA point out its cost and inequitable distributions among classes.
Lantz asked panelists where the Affordable Care Act stands today, and how it has changed under the Trump administration after an agressive but ultimately doomed campaign to ‘repeal and replace.’ Economist Gail Wilensky, former President George H.W. Bush’s senior health and welfare adviser, opened the debate by noting she believes the Trump administration has passed very little legislation with regard to the act the threat of repeal.
“Despite the efforts of not very effective Republicans in Congress, there has been precious little change on the ACA in terms of participation both by individuals and insurance companies,” Wilensky said.
Jonathan Cohn, a senior national correspondent at the Huffington Post, identified two main successes of the ACA. First, he argued, the ACA has increased human welfare and access to care through its national coverage expansion.
“These aren’t just numbers and stats, these are really people getting health care,” Cohn said.
Second, Cohn noted the ACA has changed political conversation and expectations of what the government should provide its people. Even though the ACA has been criticized by many, those same critics do not support absolute repeal.
John Ayanian, a health management and policy professor and director of the Institute of Healthcare Policy and Innovation, illustrated his firsthand experience with patients and how they have benefitted from the increased access to care. He described patients who have gone five to 10 years without care and are finally getting their chronic conditions treated. Despite its benefits, Ayanian also noted the rising prices of prescription drugs and how the ACA has not affected much change to slow the underlying cost growth.
“We have to come up with some better mechanism, particularly for paying for new breakthrough drugs that may benefit a small part of the population, but really can draw out control for public and private insurers,” Ayanian said.
In Nebraska, Cohn said, people receiving subsidies have little choice for coverage, and those above the subsidy line face prohibitive costs that force them into alternative health insurance options. These alternative options include Christian sharing ministries, which offer short-time care aimed to help between jobs. These loopholes are affordable but inefficient, and avoid federal insurance regulations the ACA was created to implement.
Wilensky explained citizens slightly above the poverty line get more subsidies than citizens with employer insurance, which she believes is unfair and leads to further instability.
“What can we do to try to stabilize these markets that will not be inherently unfair to the people right above them, or right beside them?” Wilensky asked.
Ayanian differentiated between health care and health insurance, explaining the ACA was aimed to reform health insurance, not health care. However, he stressed the importance of integrating health care and social services, arguing the U.S. is spending too much on health care services and not enough on social services to actually implement an increased access to health care.
"We’re not getting the value for the dollars we spend on health care,” Ayanian said.
Lantz asked the group what the one policy problem surrounding the ACA would they fix.
Ayanian again highlighted expanding Medicaid in the 18 states that have not yet implemented the ACA, as it would help millions of people with chronic illnesses. Cohn and Wilensky focused on the inequities brought about by the subsidy distribution, and how it is arguably a root cause of the instability brought about by the ACA. Cohn specifically suggested making the subsidies bigger and more generous, while Wilensky suggested focusing on horizontal and vertical equity.
At a Ford panel on the same topic last Februrary, students said they appreciated frank disucssion. LSA freshman Kieran Byrne said he wanted to cut through media portrayals of the healthcare debate.
“I think it’s important that people have a good idea of what’s going on in terms of the legislation that’s going to happen and what laws are already doing for us,” he said. “I think a lot of news and information is very sensationalized and it’s important to hear from the people who actually have an impact.”