Grading Obamacare

The Affordable Care Act (nee Obamacare) is five years old and controversy still rages on many fronts. The Supreme Court has ratified enough of the Act (mandatory Medicaid expansion was a loser) to keep the Act in place for the foreseeable future, but the nitty gritty details still need attention.

The Act is wildly complicated and convoluted, making implementation incredibly difficult. the Obama administration has displayed an incredible lack of administrative skill and an inability to complete projects in a timely manner.  Healthcare.gov was a symptom of a much bigger problem.

So, the grade card:

Expand coverage

Overall, in process, B-

Medicaid, out of Obama’s control

Disrupt and reform health insurance markets

In process, much more to do, outcome uncertain, C-

Mega merger in process, apparently antitrust is dead?   D

Disrupt and reform employer-employee relationships

In process, hard to measure impact, much more to do, outcome uncertain, C-

“Cadillac tax” – hated by both business and unions, that says something, D

Disrupt and reform provider system, disrupt and reform cost structures

In process, future uncertain, bundling moves forward, D 

Innovation driven by providers, B+

Rural healthcare – big trouble, D

Compliance

Late with new regs, F

Disrupt and reform information systems (EMR) *

In process, “meaningful use”  a mess, high cost, C-

Disrupt and reform information systems (ICD-10 coding changes) *

Pending October 1, outcome uncertain, providers worried, I for incomplete


* technically not a part of the Affordable Care Act