Experts weigh in on health reform

Experts attending the National Congress on Health Insurance Reform in Washington, D.C., on Jan. 19-21 expressed doubt that Republicans would be able to eliminate the Affordable Care Act, even as the House voted to repeal the law.

Some conference speakers said the Jan. 19 repeal – though largely symbolic – will cause more public confusion and take energy away from implementing the provisions.

Henry Aaron, senior fellow in economic studies at the Brookings Institution and chairman of the National Academy of Social Insurance, said the ACA is not perfect, "but it's a beginning."

"The ACA is the law of the land," he said. "Opponents have the right to try to win enough votes to repeal it. But what seems reprobate is to try and make the law of the land fail. It would be more advisable to support aspects of it."

Aaron said he would have preferred that the law supported a single national exchange instead of 50 state exchanges and incentives to purchase health insurance, rather than a mandate requiring it. He said he agrees with the way the law implements measures in increments.

Stuart Butler, distinguished fellow and director at the Center for Policy Innovation at the Heritage Foundation, said the weaknesses in the ACA will trigger vigorous debate in "some very core areas."

Over the next few years there will be serious debate over what should be included in a qualified health insurance package to satisfy the mandate, he said. The Department of Health and Human Services will be under enormous pressure from the industry over what will satisfy this requirement. Insurance companies will want their packages to be acceptable so they can be included in the exchanges, he said.

Pressure on states will also be a problem. Designs for the exchanges have yet to be fleshed out, Butler said. There is likely to be tension over whether the federal government will take the lead or the state governments.

Joseph Antos, a health advisor for the Congressional Budget Office, said both parties largely share the same goals when it comes to healthcare reform.The question is, did the ACA capture all of the goals in a way the most people would find reasonable?

Antos, who is also a Wilson H. Taylor Scholar in healthcare and retirement policy at the American Enterprise Institute and a commissioner of the Maryland Health Services Cost Review Commission, said the ACA's mandate to require health insurance isn't gong to work.

"If you have to order someone to do it, then there is probably something wrong with what you're trying to make them do," he said.  

The ACA won't provide the savings it promises unless there are across-the-board cuts to Medicare, including reimbursement cuts to physicians, Antos said.