Overspent: Inauguration Day Thoughts on the Future of Health Policy

By Cassie Chambers

In honor of today’s presidential inauguration, I started making a list of exciting past, present, and future health policies advocated by the Obama administration. Thirty minutes later there was still just one word on my computer screen: OBAMACARE. Then, I came to terms with what the next four years represent for health policy: an empty page in healthcare history, colored only by the shadow of the Obamacare fight. In short: we’ve spent all of our health policy political capital, and the next few years are all about paying off the bill.

I could perhaps accept this bleak vision of the future if I thought that the Affordable Care Act had provided solid solutions to our current problems. But the compromises needed to pass the ACA left it littered with holes—including a lack of effective cost-controls that threatens to undermine the entire system. Because of these holes, there is one more truth we have to face: however expensive Obamacare was initially, we still haven’t paid the full price.

In October, open enrollment will start for the health insurance exchanges. Yet those expecting to find affordable coverage in these markets will likely be in for a shock. The cost of exchange policies is expected to rapidly rise in 2014; the president of Aetna recently estimated this increase could be as much as 20-50%.

Why are these increases happening? Although there are many factors, one of the most important is over-stuffed essential benefits packages. Seizing the opportunities from new mandates and incentives to purchase health insurance, many medical groups have successfully lobbied to have their services included in the benefits all insurers must provide.

Don’t’ get me wrong: inclusion of some of these benefits is fantastic. But allowing important decisions like these to be made based in large part on which medical interest groups lobby more effectively probably isn’t the best decision-making strategy for society. The result is a piecemeal approach, cobbled together by politics, that has already added significantly to the cost of the ACA.

So, on a day of rhetoric about the brightness of the future, I’m stuck questioning the past. Was passing the ACA worth it? Should we have held out for a more comprehensive reform package? Is such comprehensive policy even feasible in our increasingly divided political world?

But politics, like everything, always comes full circle, and I’m sure our chance to tinker with health systems again will arrive before we know it. Perhaps, in the meantime, the best thing to do is to reload our policy arsenal with innovative ideas and get ready to seize the next opportunity for reform.

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