Report Suggests that Success of ACA Depends on Statewide Programs

Amid the 16-day government shutdown involving the Affordable Care Act, lecturers in public policy at Harvard Kennedy School, Sheila P. Burke and Elaine C. Kamarck, released a research paper last week suggesting that the long-term success of the ACA is highly dependent on the statewide programs established in accordance with the law.

“While there is no doubt that there will be many news reports related to early successes or failures, these authors emphasize that the most important metrics and outcomes will focus on the long-term implementation of the ACA and its effects on individuals, businesses, and public finances,” wrote Howard P. Forman, public health professor at the Yale School of Management, in an e-mail to The Crimson.

Both co-authors bring their past political experience to the table; Burke served as the Chief of Staff to former Senate majority leader Bob Dole, while Kamarck was one of the founders of the New Democrat movement that helped elect President Bill Clinton.

In their paper, Burke and Kamarck identify eight “key benchmarks” against which the long-term effectiveness of the ACA may be assessed. These points include the number of uninsured Americans, the cost of premiums on the exchanges and on the private market, and the number of people who are penalized for not having insurance.

In addition to providing a framework for judging the ACA, the authors of the paper summarized the political environment surrounding the newly implemented legislation.

Now that the ACA has taken effect, the states have to decide whether to create an insurance exchange for individuals and small business or to leave the work to the federal government, a decision Burke and Kamarck found to be “overwhelmingly partisan.”

Out of the 30 Republican governors currently in office, 24 have declined to set up an exchange, while 2 have opted for “partnerships”--health care exchanges run jointly by federal and state governments. By contrast, 13 of the 20 Democratic governors have decided to set up exchanges, and 5 have decided to set up partnerships.

States will also need to decide whether or not to expand Medicaid coverage, according to last summer’s Supreme Court ruling on the legislation.

“The law essentially provided for an expansion of the Medicaid program up to 133 percent of the poverty line. The perception at the time of passage is that all states would eventually expand…[but] the Supreme Court left it to the states,” Burke said.

In their paper, Burke and Kamarck found the decisions regarding Medicaid expansion to be “less partisan” than the exchange decisions. Nevertheless, the majority of Democratic governors have decided to expand the program, while the majority of Republican governors have decided against expansion, or are expected to do so.

Compared with previous health care legislations, Burke thinks that the especially bitter controversy generated by the ACA reflects a deeper political divide over the role of the federal government.