This is a guess as to what the midterms, a political setback for supporters of the Affordable Care Act (ACA), might mean for health reform. Exit polls indicate 58% of voters opposed the ACA, and cracks are beginning to show among progressives that implementation of the reform law will be difficult and fraught with political obstacles. During the campaign, Democrats fled from endorsing the health reform law, most of those supporting it lost, and Republicans will soon be holding hearings seeking to expunge or changes many of its provisions.
These cracks are beginning to show in the New England Journal of Medicine, long an echo chamber among supporters of Obamacare. Almost to the person, contributors to the “Perspective” section of the New England Journal of Medicinehave hued to the Obama health reform line, namely that the Affordable Care Act is a step in the right direction, that all will be well if only we follow its provisions to the letter, and that its implementation is inevitable and is needed to correct deficiencies in our health system.
In the October 28 NEJM issue, Henry Aaron, PhD, of the liberal Brookings Institute in Washington, D.C. sounds the alarm and breaks out of the chamber by saying, in effect, “Hey! Maybe this thing we call ACA isn’t going to work after all.”
He breaks ranks with conventional progressive wisdom by opening admitting the ACA may fail “The Midterm Elections– High Stakes for Health Policy.”
Aaron sets the tone with his opening paragraph:
“The stakes for health policy in the 2010 congressional elections are higher than they have ever been. The political parties are polarized. Policy divisions are deep. The challenges of implementing the Affordable Care Act (ACA) are enormous. The outcomes may well determine whether his landmark legislation succeeds or fails.”
And indeed, the ACA may fail, which in Aaron’s eyes would be a travesty and a tragedy.
“The nation would be left with zombie legislation, a program that lives on but works badly, consisting of poorly funded and understaffed state health exchanges that cannot bring needed improvements in individual and small-group markets, clumsily administered subsidies that lead to needless confusion and mandate that are capriciously enforced.”
This outcome might not be so bad. It would compel Congress to revisit the sloppily written law, backed unilaterally by only one party, unread by many of its ardent supporters, and fraught with adverse consequences – rapidly rising costs, curtailed benefits, and dropped coverage for millions of the the insured- already surfacing 7 months after passage.
Maybe a little bipartisan reconsideration, stalled implementation, and reversal of flawed aspects of the law, is in order before we wade too deeply into the health reform swamp. Maybe we are about to witness the unraveling of the ACA law. Maybe the affordable care act is about to be held accountable.
Richard L. Reece, MD works closely with the Physicians Foundation, a 501C3 nonprofit organization representing 700,000 physicians in state and county medical societies. He blogs at Medinnovation and is the author of “Obama, Doctors, and Health Reform.”