The Affordable Care Act, entering its sixth year, continues to pick up steam. Of course, the “sky is falling” warnings continue, including those from my University of Minnesota colleague Steve Parente (“The ACA: Trending toward terrible,” Dec 27). The reality is that health reform is covering more people for more services, improving the quality of medical care, and providing medical security for those who need care the most.
You might not have noticed through the shrill warnings and partisan rancor that much of health reform is now accepted by both political parties and has settled into the fabric of our lives. Most people accept the Affordable Care Act’s revolution in guaranteeing Americans access to insurance coverage and ending worries of being denied care because of pre-existing conditions or the onset of sudden illness. We can now claim that the U.S. provides access to health insurance coverage, that our children can be covered up to age 26 on their parents’ insurance plans, that both men and women have access to necessary cancer screenings, and that women can no longer be charged higher premiums because of their gender. None of that was true just seven years ago.
There is also growing acceptance that poor Americans and those whose low-paid jobs don’t provide insurance should be covered under the expanded Medicaid program. Despite theatrical efforts to repeal health reform in Washington, many Republican governors and state lawmakers have come to champion the Medicaid expansion, including GOP presidential candidates John Kasich and Chris Christie. This crucial part of health reform has now been embraced by 30 states that are providing coverage to more people, shifting costs to the federal government, and equipping hospitals and doctors to provide needed care.
Most of the remaining rancor is focused on one part of health reform — extending health insurance to the 6 percent of Americans of modest income who lack coverage through employers. The engines of change are “health insurance exchanges” like MNsure and federal tax credits to help individuals pay for private health plans that are available through them.
Doomsayers insist on promoting misleading bleak accounts. But there is a lot of good news — including improved health insurance coverage in Minnesota, where the uninsured rate has been cut in half from 9.5 percent in 2013 to 4.6 percent in the first half of 2015. And across the nation, more than 20 million previously uninsured Americans have gained coverage in the past five years.
You’ve seen worrisome headlines about MNsure. Some are legitimate challenges; others are misunderstandings. Much has been made of higher premiums, but that has resulted from miscalculations by local private health plans. In MNsure’s first year, PerferredOne took a gamble and underpriced its coverage to draw customers. Minnesotans flocked to some of the lowest premiums in the country. Unfortunately, its prices were too low, and PreferredOne was forced to leave MNsure. Glaring headlines about rising premiums are tracking the effort of health plans to bring premiums in line with the actual cost of coverage and medical care. Here’s the bottom line: Minnesota’s prices in MNsure are still among the lowest.
Bipartisan reforms should be made to improve access to quality care for Minnesotans and to stabilize the operation of MNsure and our safety net programs. The Health Care Financing Task Force, of which I am a member, will recommend improvements, and there may be other opportunities for reform in the coming months.
It is time to stop the scaremongering and return to the Minnesota tradition of bipartisan collaboration by embracing the successes of health reform and tackling the remaining challenges.
Lynn A. Blewett is professor of health policy at the University of Minnesota and director of the State Health Access Data Assistance Center.