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Now that the government shutdown is over and the Affordable Care Act has taken effect, how can and should policymakers judge the effectiveness of the new program? That is the question underlining a new paper, "The Affordable Care Act: A User's Guide to Implementation," co-authored by Sheila Burke, adjunct lecturer in public policy at Harvard Kennedy School (HKS).
Burke, who served as former Senator Bob Dole's (R/KS) chief of staff, collaborated with Elaine Kamarck, former domestic policy advisor for Vice-President Al Gore, and currently on leave from HKS.
"The highly politicized environment in which this law takes effect means that in the short-term people will see what they want to see," the authors write. "What we hope to do in this paper is to offer a balanced way of looking at the implementation of the law that takes us beyond today’s political situation and outline some meaningful metrics for establishing success or failure (or both) in the years to come."
Burke and Kamarck identify several yardsticks by which to measure the effectiveness of the new law over time, including:
The authors conclude that the success or failure of the national program will be very much affected by the statewide programs established in tandem with the new law.
"As we have illustrated, state choices reflect, by and large, the partisan make-up of the states. There are some states taking actions that could be seen as obstructing the implementation of the law," Burke and Kamarck conclude. "On the other hand, even some of the law’s supporters worry that the architecture of the Act and the incentive structures in it could result in adverse selection — an outcome that could affect many of the measures of success or failure discussed in this paper."