First of all, I want to make it clear that my observations are not an analysis of Hawaii whose project I was at times directly involved in but represents my observations across a number of states along with what view I had into the Federal System. These are simply my opinions from what I observed, based on many years of large system implementations.
To establish my prejudices up front… I really want the Affordable Care Act to work. Though my whole family has been involved in the medical profession and most don’t want to see anything change, my feeling is that the system is “broken” and needs to change. I particularly dislike the fact that it openly discriminates against the poor. Why should a hospital accept a much lower payment from my insurance company for a procedure then charge much more from someone who can’t afford insurance and must pay if they want to maintain their credit scores? Why do we penalize the poor if they need medical care?
Then I watch the local ER providing primary care to those same people without insurance and without formal medical care and think about how expensive an approach that is versus a more organized approach. I see insurance costs go up. I watch special interest groups to make sure that there is no way to control those costs and plenty of ways to push people out of insurance if they are actually sick.
Do I agree with everything in the act? Well, no, but at least Obama had the guts to try something rather than just let the problem continue to grow.
What don’t I like about the act? It should have been a federal program and not something that each state would independently develop. Why should taxpayers repetitively spend federal dollars to create independent systems when it all has to interact with the Federal system anyway? If states need to control their own Medicaid programs, a central federal system could go out to these systems for eligibility information just as is done in many of the state exchanges now. There should have been a public option; the only way to really keep insurance companies honest. Insurance companies should not have played such a large role in writing the act in the first place. The government should have been able to negotiate prices for medical care. Pushing out the insurance mandate to satisfy political expediencies should not continue to happen.
Then again, at least the ACA is a start and I will do whatever I can to help make it successful.