The Affordable Care Act: Ambition and Reality
On June 26, 2012, the American-German Institute (AGI) hosted a dinner discussion on “The Affordable Care Act: Ambition and Reality.” Dr. Jackson Janes (AGI) began the conversation by emphasizing the growing popularity of pay-for-performance health care systems across the U.S. and Germany as a way of addressing growing demographic and economic pressures. This topic is especially pressing in the face of the upcoming Supreme Court decision of the constitutionality of the Affordable Care Act on Thursday, June 28, 2012.
Two guest speakers, Joachim Roski (Booz Allen Hamilton) and Julie Brunner (Minnesota Council of Health Care Plans), then offered their assessments of health care reform. First, Dr. Roski stated that the Affordable Care Act (ACA) has three major aims: to provide access to health care for those with none; to improve quality health care; and to create financial rewards for well-performing hospitals. Ms. Brunner comes from a state with a tradition of very low uninsurance rates and a culture of taking care of its low-income citizens. She does not believe that going forward with the Act will be contested by her state but her concern is with the individual mandate where everyone is required to purchase insurance. If the Court strikes down the mandate but keeps guaranteed issue (the ability to be guaranteed insurance by your insurance company), then people will probably only buy insurance when they are sick. This could have devastating effects. In comparison with Germany, both countries are faced with aging populations and the health care system must shift attention from acute to chronic care.
Overall, speakers and participants were hopeful that the Act will not be struck down in its entirety. If the Court does rule the entire ACA unconstitutional, then state systems will become a lot more complicated as they each seek new ways of answering the question of how to balance quality with cost. After the decision the U.S. may become even more polarized around the topic than it currently is as it looks at the situation with opposing value systems.
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