November 12, 2012

One thing was certain in the 2012 Presidential election: the stakes were high for health care reform. Governor Romney started his campaign with standard rhetoric about repealing the Affordable Care Act (ACA), but by the end of the campaign, most pundits had concluded that repeal was highly unlikely, regardless of the outcome of the election. Governor Romney himself had started to endorse some of the more popular provisions in the law.

But there is no question that had Governor Romney won the election, the ACA would not have moved forward as envisioned by its framers. A Romney win would have created mass confusion and uncertainty in the health care world, throwing two years of implementation planning into chaos.

Now that the Supreme Court and voters have spoken, I can say with certainty: the ACA will go forward. While the law will still face implementation challenges and constrictions from opponents in Congress, the fundamentals are there, and it will be implemented essentially as designed.

That is a good thing!

It is a good thing for the millions of people who are currently uninsured and will now get health insurance.

It is a good thing for insured consumers who will now get better information and a fairer system—making the market work better.

It is a good thing for businesses that provide health insurance and compete against businesses that don’t, because it will provide a more level playing field.

It is a good thing for states: with new federal funding to expand Medicaid programs, the need for state dollars to care for the uninsured will go down.

It is a good thing for the health care system, with more resources for trying new approaches to improving the quality and cost-effectiveness of care.

It is a good thing for health plans, which will now compete more on their ability to improve the cost-efficiency of the health care system than the success of their risk selection strategies.

It is a good thing for the country at large, as it provides framework for dealing with the health care system as a system—helping to reduce the health care cost burden that crowds out other important options for investing our public funds.

I have said all along that this is not a perfect law. It is complicated, with many moving parts and chances for unintended, negative outcomes. And not everyone is a winner under the law. For example, provider payments will continue to be under pressure, individuals who don’t buy insurance will face tax penalties, businesses may change business models to reduce requirements for providing health coverage; and health plans face new regulations they may find difficult to meet.

Despite the challenges inherent in the law, the status quo is unsustainable on both human and financial dimensions. The ACA may not be perfect, but it is the right starting point. And because of this election, we can now focus on how we get things done, not whether or not we have to do them. Now we can stop delaying and start doing.

Moving forward on health care is an exciting place to be. And that is a very good thing.