The Patient Protection and Affordable Care Act, Cost Control, and the Battle for Health Care Reform

Abstract

For many social workers, March 2010 enactment of Patient Protection and Affordable Care Act (PPACA) (EL. 111-148)--later amended to include EL. 111-152, Health Care and Education Reconciliation Act of 2010--was bittersweet moment. Bitter because was less than many of us had wanted. For years, NASW had advocated single-payer system, which president and congressional leaders rejected from beginning. During debate over reform, NASW supported strong public option, which was not included in final legislation. Yet, despite this, bill's enactment was, as NASW (2010b) put (in response to enactment of House bills, H.R. 3590 and H.R. 4872), a monumental legislative achievement of our time and a significant step toward comprehensive and universal care system for our nation. Although this battle was successful, war over care reform is far from over (Aaron & Reischauer, 2010). Polls have found mixed support for legislation and confusion about its content and potential effects on various groups (Kaiser Family Foundation, 2010a). In several states, legislators have introduced bills challenging aspects of legislation, particularly mandate requiring individuals to buy insurance, and others have scheduled ballot referendums to determine whether citizens can refuse to comply with legislation (Cauchi, 2010). In addition, several state attorneys general have brought suit against law (Lazarus & Morrison, 2010). Opponents of reform pledged to and the procedures used to enact it an issue in 2010 elections (Aaron & Reischauer, 2010). Supporters of reform hoped that once legislation became law, opposition would dissipate; however, middle of May 2010, this had not happened (Pollster.com, 2010). The complexity of law, critical role of states in carrying out, and legislation's implementation schedule make likely that reform will be an arduous process (Aaron & Reischauer, 2010). Aaron and Reischauer (2010) warned that unless supporters of reform face up to challenges, health care reform could go way of Medicare Catastrophic Coverage Act of 1988, which was enacted with almost self-congratulatory enthusiasm but, due to strong opposition from consumers, was repealed year and half later (p. 1260). A critical issue facing supporters of PPACA is whether can succeed in reducing care inflation. Although latter has slowed in recent years, remains serious concern. Between 1999 and 2009, employer-based insurance premiums increased 131 percent, more than three times worker wages and four times general inflation (Kaiser Family Foundation, 2009). Health care inflation, in form of increased Medicare expenditures, also lies at root of our much discussed budget and crisis (Orszag, 2009). Opponents of PPACA argue that will worsen care inflation. At President Obama's summit, Representative Paul Ryan (R-WI), ranking Republican on House Budget Committee, warned that Senate bill, which was similar to final version, failed to control costs or [the] deficit and engaged in double-counting and other gimmicks (Rep. Paul Ryan on Health Inflation, 2010). After enactment of final bill, Ryan stated that these bills would exacerbate our fiscal crisis adding trillions of dollars to our debt burden (Ryan: 'This Heavy-Handed Overhaul', 2010). What is reality? The Congressional Budget Office (CBO) and staff of Senate's Joint Committee on Taxation estimated that health-related sections of bill (the legislation also included education provisions) would reduce budget $124 billion between 2010 and 2019 and by ... around one-half percent of gross domestic product during following decade (Elmendorf, 2010b). …