Round 2 for the Affordable Care Act: The Agenda for Nonprofits

By Rick Cohen

          Nonprofit Quarterly

One year ago, the launch of the Affordable Care Act was so troubled and chaotic that the very survival of national health insurance reform seemed to be at risk. Now, despite the huffing and puffing of the likes of Senator Ted Cruz, the Affordable Care Act has been firmly ensconced in public policy, joining Medicare and Medicaid as the most significant changes in American social policy since FDR’s promulgation of Social Security.

Like the Affordable Care Act, Social Security had a troubled launch, albeit without the grandiosity of a web portal disaster like HealthCare.gov, and faced scathing attacks from the 1930s’ versions of the Koch brothers, but now just about no one would be so politically stupid to call for the repeal of Social Security.

Notwithstanding the likelihood of vainglorious attempts by some to call for repealing the Affordable Care Act, it is all but obvious that national health insurance reform has gained a permanent place in the nation’s array of social welfare policies. As Politico noted, even “the insurance industry believes Obamacare is here to stay no matter who wins control of the Senate this fall.” The impacts and indicators of success of the Affordable Care Act are visible and measurable:

• Over 10 million Americans who were previously uninsured now have health insurance—at least 7.5 million through the exchanges and another 3 million through expanded Medicaid.

• The proportion of Americans who are uninsured has plummeted, though at 13.4 percent, it is still unacceptably high.

• Despite fears of skyrocketing insurance premiums, the insurance companies’ requests for rate increases this coming year average around 8.2 percent— significantly less than the typical average annual increase in the past—and premiums are 15 percent lower than the Congressional Budget Office had predicted.

• While long-term healthcare outcomes will only really be demonstrable with time, as a result of the Affordable Care Act, many people who were barred from health insurance due to preexisting conditions are now eligible for coverage. Others who could not afford the cost are now able to get coverage due to federal subsidies (or, in many states, expanded Medicaid) and the competitive health insurance marketplaces have led insurers to improve their offerings, reduce their, and make changes in response to consumer wants and needs that simply did not happen pre-ACA.

Despite these and many other indicators of Affordable Care Act achievements and successes, there is much yet to be done to work through problems and shortcomings in the parts of the nation’s healthcare system. That’s where there are important roles for nonprofits, not just health-related nonprofits such as clinics and hospitals...

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