TWO OF THE NATION'S LEADING HEALTH CARE ECONOMISTS provide both praise and critique of the Affordable Care Act (ACA) in an essay published today in the Journal of the American Medical Association (JAMA). The essay—co-authored by Amitabh Chandra, Malcolm Wiener Professor of Social Policy at Harvard Kennedy School (HKS), and Jonathan Skinner of Dartmouth College—is in response to a JAMA article authored by President Obama touting the successes of his signature health care reform program. 

“With an estimated expansion in health insurance of 20 million individuals, President Obama is right to claim credit for the ACA. But counting the number of individuals with insurance is not enough to assess if the ACA was a success,” Chanda and Skinner write. “Perhaps the more important measures are whether the ACA improved health and saved money.”

The authors argue that the development of accountable care organizations (ACOs), one of the primary features of the ACA, has resulted in “achieving improvements in health care process measures, timely access to physicians, and overall patient satisfaction,” but they claim that some ACOs “do not know their cost structure, have little control over loosely affiliated physicians and are prohibited from implementing patient cost-sharing for unwarranted treatments.” 

Chandra and Skinner agree that the rate of growth of health care costs slowed during the period of 2010-14, but they do not believe that the slowdown can be attributed to the passage of ACA.  They also note that costs began rising again—at an unsustainable rate of 8.1 percent, nearly double the growth of the gross domestic product—between March 2014 and March 2016. 

“This pressure on health care cost increases is not likely to moderate,” the authors say.  “Whether future administrations (and Congresses) decide to dismantle the ACA or strengthen its foundations, they still must confront the unique challenge of getting health care spending under control—no insurance program is ‘affordable’ as long as health care cost increases consistently exceed the growth of the gross domestic product.”  

The authors conclude that “even though the ACA has, to this point, not accomplished its goal of making health care more affordable, it is also far more moderate, innovative—and difficult to replace—than its critics claim.”

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