|Oberlander’s NEJM ‘Perspective’ outlines challenges facing the Affordable Care Act|
|November 26, 2012|
Who among us has read the 2,409 pages of the Affordable Care Act (ACA)? Jonathan Oberlander, PhD, is one of a tiny minority.
Oberlander, professor of health policy and management in Gillings School of Global Public Health and of social medicine in the School of Medicine at The University of North Carolina at Chapel Hill, is called upon frequently to analyze and discuss the tenets and repercussions of the law. His most recent analysis, "The Future of Obamacare," was published online Nov. 21 as a Perspective in The New England Journal of Medicine.
"Obamacare" is the name at first disparagingly assigned to the ACA, then appropriated by President Obama as a positive moniker for the most significant health care reform legislation since Medicare and Medicaid were passed in 1965.
Oberlander's essay focuses primarily upon the role of the individual states in the successful implementation of the law. Only 16 states and the District of Columbia have so far committed to establishing their own health care marketplaces, or exchanges, and 22 will yield to the federal government's setting up their states' exchanges or will co-sponsor their programs with the federal government.
Questions remain about whether all the exchanges will be ready for the enrollment period scheduled to begin in October 2013. Legal challenges, though considerably lessened given the President's reelection, might include arguments regarding mandated coverage for contraception.
States also must decide whether to expand eligibility for their Medicaid programs. "Most low-income, uninsured residents in states that do not expand Medicaid will be ineligible for subsidies in the exchanges and will therefore remain without coverage," Oberlander writes.
Oberlander describes three long-term challenges to the success of the legislation - political and public opinion opposition; absence of a clear, well-articulated identity for the program; and cost control.
"More than two and a half years after its enactment, the public is still deeply divided over Obamacare," the author writes. He says that division:
Oberlander's article is available online.
|Last updated November 26, 2012|