The (Un) Affordable Healthcare Battleground

The Affordable Care Act was doomed to be a partisan battleground. Passed by a lame duck Congress in 2010, it was a rough draft, intended to be refined and repaired in conference committee when the Democrats had the majority in the House.  The 2010 elections flipped control of the House, leading the Democrats to pass it without a single Republican vote, after no serious attempts at bipartisanship, and without being able to fix its known flaws.

It’s been over 4 years since passage and the early wins the law was designed to provide have shown up in increased numbers of people with health insurance, although more than expected has been through Medicaid expansion.  As the tortured economics of the ACA have been unraveled, it’s becoming clear the cost will be much higher than anticipated. The Affordable Care Act is unsustainable.

So what next?  Reality is what’s next. The ACA will not be repealed. Oh, there will be another repeal bill passed by Republicans as political theater to demonstrate they’re listening to their base.  But reality is that even if a repeal bill was passed with a perfectly crafted replacement ready to slide into place, President Obama would never sign it.  And to Democrats who like to hold out for moving to a single payer system, that’s not happening either.  It’s time for everyone to move on.

When intervening in any complex system, and healthcare is certainly complex, it is essential to monitor for the earliest signs that things are going wrong. If you only monitor for anecdotes and statistics confirming you were right, you’ll miss critical correction points. Authors of any legislation must assume they are wrong, and that’s a tough position for any politician.

Republicans as a whole have been quick to point out what’s wrong, a little slow to acknowledge what’s working so far. On the other hand, Democrats demonize anyone who wants to talk about problems. Neither attitude is useful.

There are pieces of the ACA that have been helpful to some people.  There are pieces of the law that just reauthorize and extend existing programs and are not controversial.  There are pieces of the law that have caused new problems, the unavoidable unintended consequences that accompany any complex legislation. There are pieces of the law that have hurt people now and will in the future. There are critical concerns about what happens when the hidden subsidies disappear and the economic energy is drained.

Facing reality isn’t a partisan enterprise.

Join me on Better Health podcasts on and follow this blog to explore where we’ve been, where we are and where we’re going. Doing nothing is not an option.

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