What Still Ails Us a Decade After the Affordable Care Act?
EPISODE 6: Nancy-Ann DeParle, former deputy chief of staff to President Obama, and Larry Van Horn, associate professor and director of Health Affairs at Vanderbilt University’s Owen Graduate School of Management, join Governors Bredesen and Haslam to discuss the Affordable Care Act and what else we can do to lower healthcare costs and improve outcomes
To check in on the healthcare system more than a decade after the Affordable Care Act became law of the land, Governors Bredesen and Haslam spoke with one of its primary architects, Nancy-Ann DeParle, managing partner and co-founder of Consonance Capital Partners and former senior advisor to President Obama, and a critic of the law, Larry Van Horn, associate professor and director of Health Affairs at Vanderbilt University’s Owen Graduate School of Management.
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“He’s got a good idea”
DeParle recounted how the bill came together, from why President Obama decided to take on such a contentious issue (“doing nothing was unsustainable and also unacceptable”) to the idea that prompted former Senate Majority Leader Harry Reid to tell her, “That’s the stupidest thing I’ve ever heard.”
While the final bill achieved the president’s main policy objectives, DeParle did identify one regret.
“My biggest regret about the law isn’t the policy, it’s that it was not bipartisan in the end,” she told Governors Bredesen and Haslam. “I could go through page by page and show you ideas that were contributed by Senator Grassley. In fact, one that’s happening right now. There are new requirements for hospitals across the country and for insurance plans to be transparent about their prices. And that’s something that Senator Chuck Grassley argued for. And, you know, to the name of your program, ‘You Might Be Right,’ I sat there and I thought, ‘You know, I think that’s right. He’s got a good idea.’ Went back to the president, and he said, ‘Chuck’s right, we should do that.”
“A lost opportunity”
Van Horn, a longtime critic of the Affordable Care Act (“I was not terribly enthused at the time it was being advanced. Nothing’s changed in 10 years,” he said), explained that his frustration stems in part from what the law did not do.
“We have very limited opportunities to engage in the policy conversation around healthcare, period. And I view what happened with the ACA as a lost opportunity to address the healthcare needs of the United States from a policy perspective,” Van Horn told Governors Bredesen and Haslam. “And my high level is…we picked up the insurance for about 15 million people, net-net. There were transfers around employer versus Medicaid versus the subsidized market. But 15 million people got more insurance coverage. But we’ve got 330 million Americans in the United States, and it did very little to address the fiscal realities facing Americans around healthcare.”
“The transparency’s got to improve a lot”
One place where DeParle and Van Horn did seemingly agree? That more price transparency in healthcare could go a long way. They used similar anecdotes to explain how a lack of transparency contributes to the current situation.
“You’d never go into a store in Nashville and buy that shirt and have them tell you, ‘Well, we’ll let you know later how much it’s going to cost,” DeParle told Governors Bredesen and Haslam. “You would not do that. But that’s a little bit the way we expect the healthcare market to work. The transparency’s got to improve a lot. And the accountability.” Van Horn made a similar point. “To me, U.S. healthcare is like pulling into a gas station, filling your car up with gas and not knowing ‘till after the fact whether you pay $2.50 a gallon or $12 a gallon,” he told the Governors. “That actually is the amount of price variation for services in a market for U.S. healthcare.”
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