Much of the media coverage and dialogue surrounding the Affordable Care Act (ACA) has been, unsurprisingly, polarizing. Opponents have focused on the negative (the bumpy rollout of the federal health insurance marketplace, healthcare.gov), supporters on the positive (the 8 million enrollments through the marketplace). Health policy expert Benjamin Sommers of Harvard School of Public Health (HSPH) says it’s really too soon to assess the law’s full impact.
“My report card reads, ‘Incomplete. But off to a promising start,’ ” wrote Sommers in a May 2014 Harvard Public Health Review opinion piece titled “ObamaCare’s 2014 Report Card? Preaching Patience — to Supporters and Opponents.”
Although the marketplaces are “the most novel portion of the ACA,” said Sommers, assistant professor of health policy and economics at HSPH, focusing solely on them is only part of the story. A fuller assessment of the health care law would also take into account its impact on expanded Medicaid coverage; on employer-sponsored health insurance; and on expanded coverage among those previously uninsured because of pre-existing conditions—no longer an issue because of the ACA’s elimination of the exclusion for such conditions.
Sommers said the most relevant initial benchmark about the ACA is what its impact has been on those without any health insurance—and early evidence suggests that the number of uninsured is indeed falling. As for its longer-term effects on health care access, financial protection, health, and mortality, “we are still far from being able to assess these more important downstream impacts of the law,” Sommers wrote.
Do enrollment targets matter? (HSPH video)