ACA was great starting point, but more must be done to improve U.S. health care system

While the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) was a great starting point, more must be done to improve the U.S. health care system, according to a recent article published in the Journal of the American Medical Association (JAMA). According to David Blumenthal, M.D., president of the Commonwealth Fund, if health care costs had increased since 1980 at the rate they did in Switzerland, the U.S. could have saved nearly $15.9 trillion, or enough to retire the national debt. And, if the national rate of health insurance coverage was the same as the average of the five U.S. states with the highest coverage rates (Massachusetts, Vermont, Hawaii, Washington, D.C., and Iowa), an estimated 20 million more Americans would have had health insurance coverage in 2014. Blumenthal examined three areas where the U.S. can make large improvements in the health care system.

Expanding access to health care services. This is where the impact of the ACA is most evident. Uninsured rates stand at a historic low of 9 percent. Blumenthal suggested continued gains by broadening the ACA’s Medicaid expansion to additional states and by ensuring the viability of the insurance marketplaces by reaching out to and educating a diverse population of individuals, especially healthy individuals. Finally, he stressed that maintaining the ACA’s individual mandate is crucial, especially for individuals ages 18 to 34 years, who have resisted acquiring insurance in the past.

Controlling the costs of care. The last five years have been marked by modest health care growth, although at 3 percent to 5 percent annually, this growth has still outpaced inflation. Maintaining this low growth rate will require a move away from fee-for-service reimbursement and toward approaches like accountable care organizations and bundled payments, noted Blumenthal. Controlling the cost of prescription drugs also will be important.

Improving quality of care. Reforming payment to reflect and reward the quality of care will require simplified measurement systems, data collection that can deliver feedback in close to real time, and the ability for medical information to follow patients through the health care system, said Blumenthal.


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