CSA Health Care Interview Series: Interview with Center for American Progress Health Policy Director Maura Calsyn
As the American health care sector is rapidly changing with the passage and implementation of the Affordable Care Act, CSA’s Director of Policy Andrew Smith conducted a series of interviews with health care experts in order to better understand the future of the health care sector and its impact on American Millennials. Featuring diverse perspectives on these dynamic issues from both sides of the aisle, Andrew interviewed Manhattan Institute Senior Fellow Avik Roy, Third Way Senior Fellow David Kendall, and Center for American Progress Health Policy Director Maura Calsyn in order to capture some conservative, centrist, and liberal perspectives on the rapidly changing health care sector. Read Andrew’s interview with Ms. Calsyn below or his interviews with Mr. Roy and Mr. Kendall on CSA’s policy blog.
Mr. Smith: What has been the biggest success of the ACA implementation to this point? Biggest failure? When and how will we know for certain whether Obamacare succeeded or failed overall?
Ms. Calsyn: The law has successfully lowered the number of uninsured Americans. More than 10 million more people now have health insurance coverage thanks to Medicaid expansion and policies bought in the new marketplaces, and the uninsured rate has dropped 25 percent.
I think we already know that the ACA is successful. Not only has the number of uninsured dropped significantly, but all consumers are protected by the law’s reforms. For example, you can’t be charged more for insurance if you’ve been sick or an insurance company thinks you have a greater risk of needing care. Before the ACA insurers could deny you coverage or charge more in those cases. We’re also starting to see more evidence that the law has helped moderate health care cost growth.
But the decision by over 20 states not to expand their state’s Medicaid programs has blocked almost 4 million Americans from benefiting from the law.
I think the real question is whether the law is allowed to continue to build on these improvements. Despite these successes, opponents of the law continue their efforts to repeal or seriously undermine the law.
Mr. Smith: What kind of reforms could help the ACA work better from your point of view? Do you see any areas where bipartisanship could be possible?
Ms. Calsyn: The most important next step is for states to agree to expand their Medicaid programs. In a number of states lawmakers and governors from both parties have worked together to take this critical step.
Some ideas that build on the ACA could have bipartisan support. For example, the Center for American Progress has proposed allowing states to become “Accountable Care States”—meaning that they are accountable for health care costs, the quality of care, and access to care—with sizable financial rewards for keeping overall – both public and private – costs low. This model would control costs across the system rather than shift costs from public programs to the private sector or to consumers. Improving price transparency is another area where there is bipartisan agreement that more needs to be done to help patients compare cost and quality.
Mr. Smith: What should be the health policy goals of progressives in a post-ACA world?
Ms. Calsyn: We should continue to work on lowering costs and improving quality, using the framework established by the ACA. There are also changes that could help make health care more affordable for consumers.
Mr. Smith: As college students, we worry when we see the projections of dramatic increases in health spending and wonder to what extent it will hamper our generation. How pessimistic are you about long-run health spending, and what are policy options that could have us in better shape in the future?
Ms. Calsyn: I think there is reason to be cautiously optimistic, because we’re making progress in addressing the growth in health care costs. From 2010 through 2013, national health care spending per person, adjusted for inflation, grew by only 1.1%—the slowest rate on record.
The reasons for these slowdowns differ depending on what part of the health care system we are talking about. In the private market, the recession most certainly had an impact. People with employer-sponsored insurance who lost their jobs also lost their insurance. And even those with insurance had less money to spend on their health care. In addition, employers have been shifting costs to their employees, by increasing premiums, deductibles, and other cost-sharing. The recession and cost-sharing contributed to most of the slowdown in private spending.
But Medicare costs are also slowing down. Part of the reason why is because of the increased number of lower-cost generic drugs in recent years. But another reason why is that we are likely seeing some larger changes to how health care is delivered, because of reforms in the Affordable Care Act. The law changed how Medicare pays hospitals, doctors, and other health care providers to reward higher quality, lower cost care.
Moving forward, it is critical to build on these reforms to make sure that these changes are permanent. The system should continue to move away from “fee-for-service” payments – paying providers separate amounts for each service they perform, regardless of whether it is needed – towards value-based payments. And we should look to the states to help lower costs, as the Accountable Care State proposal would do.
Maura Calsyn is the Director of Health Policy at American Progress. Prior to joining the Center, Maura was an attorney with the Department of Health and Human Services’ Office of the General Counsel. During her time there she served as the Department’s lead attorney for several Medicare programs and advised the Department on implementation of the Affordable Care Act. Before joining the Office of the General Counsel, Maura worked as a health care attorney at two international law firms. Maura’s interest in health policy and law began when she worked as a health care legislative assistant for Rep. Anna Eshoo (D-CA) before attending law school. Maura is a graduate of Hamilton College and Harvard Law School.