The ACA takes major steps towards reversing the failures of our market-driven system. The central feature of the new law addresses fears that losing a job, retiring early or starting a small business could result in being denied access to affordable health coverage. It does this by providing tens of millions of Americans with income-based subsidies to purchase coverage from regulated private insurance companies and by dramatically expanding public health coverage for the working poor in Medicaid. The legislation also requires employers to contribute to coverage and sets higher minimum standards for employer coverage.
The new law begins to tackle the problem of high healthcare costs by making changes in how Medicare reimburses providers. In Massachusetts, RomneyCare—structurally almost identical to ObamaCare—is beginning to demonstrate that the overall architecture of reform can play a catalytic role in controlling healthcare costs. Massachusetts is using the power to restrict the entry of insurance companies into the new health market—called “exchanges” in the federal law—to negotiate with these insurance companies for high quality coverage at lower prices. The pressure to control expenditures created by the state’s new responsibility to help pay for the uninsured led Governor Deval Patrick to squeeze the insurance companies. They, in turn, are leaning hard on the big academic medical centers, which are the major drivers of costly and often wasteful care. With 95 percent of Massachusetts residents now insured and likely to have a primary care provider, emergency room use is starting to decline.
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via In Defense of ‘ObamaCare’ | The Nation.