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Reflections on the Affordable Care Act

By Kris Helé

I recently attended a wonderful lecture through UC Berkeley Extension by UCB Public Health Professor William Dow. “Health Care Reform Update: Post-Affordable Care Act (ACA) Progress and Challenges” was an unexpectedly satisfying way to spend a sunny Saturday afternoon. It was a quick, digestible run-down of what health care reform entails, what’s been implemented to date and what’s coming in 2014 with full implementation.

I left the session with a number of key take-aways to inform not only Informing Change’s health practice but my own perspectives about health care reform. For instance:

  • By 2016, after a couple years of full implementation, an estimated 3 million people in California will still be without coverage, mostly immigrants. Though we knew the ACA would not provide universal coverage, this is a sobering statistic for a policy whose primary purpose is to expand health insurance.
  • Public opinion is split on so-called “Obamacare.” However, more than half of individuals polled say they really don’t have enough information about the ACA to back up their strong opinions. Fortunately, many organizations—Kaiser Family Foundation, California HealthCare Foundation and the Department of Managed HealthCare, for example—are trying mightily to get the word out to address the information gap.
  • If we were to start over and initiate truly transformational change in the health care system, many would recommend scrapping the dysfunctional employer-based system that dominates health insurance pre- and post-ACA. Still, the ACA is what we’ve got, and what many fought hard for, so we better make the most of it.

The most provocative point Dow made was during the Q&A session, when he dispelled the myth that health prevention efforts equal cost savings. I couldn’t believe my ears—a public health professor really just said that? Sacrilege! With his economist hat on, Dow says that only a handful of preventive interventions are truly cost saving—smoking cessation and flu vaccines are among them. Other prevention strategies require a large investment of money in the system, and so they ultimately may not save costs, but may still be the right and worthwhile thing to do.

Dow’s recommendations for cost-effective, impactful societal investments? 1) Education. 2) Education. 3) Education. This is a reminder that it’s not only important to think about what we’re spending our money on—the ACA comes with a $1.7 trillion estimated price tag over 10 years—but what we aren’t spending it on instead.

I left the lecture reaffirmed, with an abiding sense that the ACA is the right thing to do, if not the perfect way to do it. But in the coming years, we must see the policy fulfill its promise of reducing the number of uninsured, as well as deliver on other goals of improving health, increasing equity and slowing health care costs. May the provisions of the policy stand strong until these outcomes are borne out, and until the ethos of quality, equity and affordability become forever embedded in our approach to health care.

Note: Any errors in my recollection or interpretation of Dow’s lecture are entirely my own.