KHN’s ‘What the Health?’: The ACA Turns 12
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KHN’s ‘What the Health?’: The ACA Turns 12


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The Affordable Care Act, aka Obamacare, turned 12 this week, in spite of efforts to repeal it through both legislation and court action over much of its lifetime. But key decisions facing federal and state lawmakers and the Biden administration in the coming year will say a lot about how many Americans the law ultimately benefits, and how much it will benefit them.

Meanwhile, three leading credit bureaus announced they would stop using most medical debt to determine U.S. consumers’ creditworthiness. The move comes shortly after the federal Consumer Financial Protection Bureau threatened to make the agencies eliminate the use of medical debt in consumer credit reports.

This week’s panelists are Julie Rovner of KHN, Anna Edney of Bloomberg News, Rachel Cohrs of Stat, and Mary Agnes Carey of KHN.

Among the takeaways from this week’s episode:

  • Administration officials this week celebrated the 12th anniversary of the Affordable Care Act, which brought major changes to the U.S. health care system, including expanding private insurance coverage and Medicaid coverage to millions of people, banning restrictions based on preexisting medical conditions, providing no-cost preventive care, and adding restrictions on health insurers’ profits.
  • Republicans appear to have lost momentum on repealing the law, and in many ways the public now takes the law for granted. But HuffPost’s Jonathan Cohn points out that key provisions could still face disruption in the coming year, including significant premium subsidies that Democrats added to the ACA in 2021. Those are not permanent and would need to be extended by Congress.
  • A recent report by the nonprofit Commonwealth Fund found that many young, healthy people have migrated off ACA exchange plans — which guarantee a wide range of benefits — to cheaper, short-term plans, which were promoted as an alternative by the Trump administration but do not have as many consumer protections. If that migration continues over the long term, the loss of healthy individuals from the ACA plans could undermine the risk pools for those insurers. ACA advocates are watching to see if the Biden administration puts new restrictions on the short-term plans, but that may not be a priority at this time.
  • The announcement last week by the leading credit rating agencies on medical debt will not provide relief to people who already have those bills on their record, as well as those with the largest unpaid bills.
  • As state legislatures around the country begin wrapping up their sessions, action is growing on abortion bills. Idaho’s governor signed a law this week banning abortions and calling on individuals — not state officials — to enforce it through lawsuits. That enforcement mechanism is the same one pioneered by Texas and, so far, not barred by the Supreme Court. The South Dakota governor, meanwhile, signed a law restricting the availability of abortion pills.
  • Public health officials warn that as the country moves to loosen covid restrictions, there is inadequate testing to spot any resurgence or provide confidence for consumers. The White House says Congress needs to appropriate more money for covid protections, including the purchase of more tests and vaccines. But that funding was left out of the recent government spending bill because Republicans and Democrats couldn’t agree on what was needed or how to pay for it.
  • The White House appears not to have realized before that vote in Congress that the covid spending was in trouble and failed to signal to Capitol Hill the ramifications of not acting. It may turn out to be a costly miscalculation if the country has another major covid wave and the government doesn’t have appropriate tools to fight it.
  • Administration officials appear to be working to sway Republican senators and have promised more information about covid spending and possible options for savings to Sen. Mitt Romney (R-Utah).
  • Meanwhile, on Capitol Hill, the House is not in a rush to consider the Senate bill to switch the nation permanently to daylight saving time. House leaders say they want to study the measure — which breezed through the usually slow-moving Senate this month — and some sleep experts suggest that if the national policy changes, it might be better to go permanently with standard time, instead of daylight saving time.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: KHN’s “As States Impose Abortion Bans, Young Doctors Struggle — And Travel Far — To Learn the Procedure,” by Sarah Varney

Anna Edney: Politico’s “‘We’ve Learned Absolutely Nothing’: Tests Could Again Be in Short Supply if Covid Surges,” by David Lim

Rachel Cohrs: The Guardian’s “‘Betting Against the NHS’: £1bn Private Hospital to Open in Central London,” by Julia Kollewe

Mary Agnes Carey: KHN’s “Covid’s ‘Silver Lining’: Research Breakthroughs for Chronic Disease, Cancer, and the Common Flu,” by Liz Szabo

Also discussed on this week’s podcast:

HuffPost’s “The Affordable Care Act Turns 12 Today, and It Could Look Pretty Different by Year 13,” by Jonathan Cohn

Stat’s “The Breen Bill to Protect Health Providers Is Well-Intentioned. But It Won’t Stop Burnout,” by Greg Jasani

The Commonwealth Fund’s “Short-Term Health Insurance Markets and the ACA,” by Mark A. Hall and Michael J. McCue


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