Becker's Hospital Review

12 2015 YEAR REVIEW in PERSPECTIVE BECKER'S 7 th Annual Meeting 2016 April 27-30, 2016 | Hyatt Regency, Chicago Register at http://www.beckershospitalreview.com/conference/ of people without insurance has moved but that movement in the right direction may be eroding. Originally, the CBO estimated that 20 million more people would have health insurance under the ACA. at number is probably closer to a net of 10 million people with coverage. An Oct. 25 Wall Street Journal article titled "e Decline of ObamaCare" states: "is month the Health and Human Services Depart- ment dramatically discounted its internal estimate of how many people will join the state insurance exchanges in 2016. ere are about 9.1 million enrollees today and the consensus estimate — by the Congressional Budget Office, the Medicare actuary and independent analysis like Rand Corp. — was that participation would surge to some 20 million. But HHS now expects enrollment to grow to between merely 9.4 million and 11.4 million." An HHS survey found among the uninsured population, about half are between the ages of 18 and 34, and approximately two-thirds are in excellent or very good health. e survey shows three-fourths of uninsured people who are eligible for coverage under the ACA believe having coverage is important, but four out of five of those people say they cannot afford their share of the premiums, even with financial assistance, according to the Wall Street Journal. Another commentator states in a July 9 Slate article titled "Obamacare's Bill is Due": "e problem is simple. As Trudy Lieberman reported this month in Harper's, the ACA made a decent stab at solving the problem of Americans lacking insurance. Unfortunately, the bar- gain struck to get the bill to a point where lobbyists for the hos- pital, insurance, and pharmaceutical industries to sign on, or at least not fight it, did not adequately address the issue of overall medical costs." In a July 25 New York Times article by Paul Krugman titled "Hooray for Obamacare," he states in contrast: "e Affordable Care Act is now in its second year of full operation; how's it doing? e answer is, better than even many supporters realize. Start with the act's most basic purpose, to cover the previously uninsured. Op- ponents of the law insisted that it would actually reduce coverage; in reality, around 15 million Americans have gained insurance. But isn't that a very partial success, with millions still uncovered? Well, many of those still uninsured are in that position because their state gov- ernments have refused to let the federal government enroll them in Medicaid." Currently, 20 states have not expanded Medicaid. 7. Democrat versus Republican perspectives. e Demo- crats may state that if there are problems with the ACA it is due to the fact that the government might not have gone far enough in creating a single-payer system. e Republicans might state the growth of the ACA has led to substantially increased costs to taxpayers and for healthcare without concurrent benefit. It is unlikely that the Republican administration of any sort would be able to wholly derail the ACA or repeal it. Further, if things become complex and expensive enough in healthcare, it could also actually create momentum for a dreaded single-payer plan, which in some other countries has delivered anecdotally very negative care. 8. High deductible plans. e ACA has led — ironically enough — to significant growth in a long-term Republican tenet of healthcare reform, which is the use of high deductible plans and consumer driven plans. e Internal Revenue Service de-

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