Commentary on part IV: From personal to political to policy—what next?

Abstract

The Affordable Care Act was a remarkable public policy accomplishment that will forever define President Obama’s legacy. However, the ACA is only part of a much larger set of changes occurring at the federal, state, and market levels that are shaping the future of what we call healthcare reform. As a result of the Supreme Court’s decision, the expansion of Medicaid, which is a lynchpin of the ACA’s access provisions, will depend on decisions made in 50 state capitals. The ACA is acting as a powerful accelerant that is beginning to reorient the healthcare system toward a greater emphasis on preventive care, value over volume, wellness, and health outcomes. Still, the final verdict on healthcare reform will be written by the complex interplay of innumerable decisions made by providers, insurers, and consumers. However, the experience of Massachusetts suggests that many of the concerns about the ACA-that it is fiscally unsustainable, will drive up costs, result in numerous“unintended consequences”-are in fact overblown.