BOSTON -- When it comes to the president’s health care law, there’s very little that Republicans and Democrats agree on—but one idea that seems to unite analysts, experts and lawmakers across the political spectrum is that Obamacare has done very little to actually improve health care.
“The U.S. healthcare system was always dysfunctional. The Affordable Care Act has just provided more access to that dysfunctional system,” iVantage chief Donald Bialek said during an ACA debate at The Economist’s health care forum in Boston on Wednesday. Bialek, for his part, was on the side defending the health care law.
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It’s a common theme for ACA supporters to tout the law as a success in terms of providing access to coverage—after all, some 8 million people signed up for health care on the federal or state exchanges this year. And the national uninsured rate has fallen to record lows since the law’s implementation.
Just this week, the Centers for Disease Control reported that the uninsured rate fell to 13.1 percent during the first three quarters of the year—a 1.3 percent drop from the first quarter of last year, reflecting a decline of 3.8 million uninsured in the country. Even those who were hesitant to embrace the law are starting to see positive results.
“Even though it cost our industry a lot of money, the exchanges are helping bring coverage people that weren’t able to get it before,” Humana’s chief executive Bruce Broussard said.
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But where the law falls short, many say, is with the care itself.
“The Affordable Care Act should really be called the Affordable Insurance Premiums Act.” Broussard said although more people have health insurance, the law does nothing to improve the care they receive with that health insurance. “Obamacare didn’t really address that and we still have a long way to go in that respect.”
There are several provisions in the ACA that are meant to improve the quality of care like Hospital Value Based Purchasing, which rewards or penalizes hospitals depending on their performance. However, that provision has not led to any substantial improvements in care so far, one study found.
Another measure penalizes or rewards hospitals for their re-admittance rates. That program was flagged earlier this year by a panel of 26 experts who said it could unintentionally hurt hospitals that serve a disproportionately large share of low-income people. Regardless, many experts say it’s still too early to measure the effectiveness of these types of programs.
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Meanwhile, health experts say that when it comes to health care reform, one of the most important issues is the way doctors are paid.
Health economists agree that the U.S. health care system should shift away from the traditional fee-for-service model.
“There is a serious problems with incentives and professional culture and expectations of people that needs to be addressed,” said Peter Berman, a professor at Harvard’s School of Public Health. “Fee-for-service rewarded us for doing highly interventional things; changing those incentives is key to reform.”
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