Ways the ACA Could Be Improved Edition of the Health Wonk Review

by Louise Norris

Source: Colorado Health Insurance Insider

In Colorado, the snow is melting and the flowers are blooming. The health wonks around the blog world have given us an excellent collection of articles this week, many with suggestions of ways the ACA could be improved.  Our favorite part of hosting the HWR is reading all of the different perspectives that the writers bring to the table.  There’s a little something for everyone here. Let’s watch the snow give way to wildflowers as we check the pulse on the latest healthcare dialogue from the worlds biggest health wonks.

Welcome to the Ways the ACA Could Be Improved edition of the Health Wonk Review!

Writing at John Goodman’s Health Policy Blog, Linda Gorman questions the claim that failure to expand Medicaid will cause up to 17,000 deaths per year.  Although I’m very much in favor of Medicaid expansion in every state, Linda’s post is thoughtful and detailed, and I always like to see data and claims deconstructed and thoroughly examined rather than just accepted.  Linda focuses particularly on data that purports to show a steady decline in nonelderly adult mortality rates in states that expanded Medicaid long before the ACA, including New York, Maine and Pennsylvania.  She points out that the World Trade Center attack creates a spike in the mortality rate graph at the time that Medicaid was expanded in NY, leading to a subsequent decrease in death rates the following year.  And the availability of antiretroviral therapies for HIV have dramatically lowered mortality rates from HIV since the mid-90s, which could explain some of the lowered mortality rates – particularly in NY – over the past 15 years or so.  HIV is an interesting discussion point though, since the government has a program to help people pay for their HIV meds even if they are uninsured.  Unfortunately, there are plenty of other medical conditions that are similarly expensive to treat but do not have assistance programs available for uninsured people – hence the need for expanded Medicaid or something similar.  Although this is certainly a discussion that pertains to ways the ACA could be improved, the question of whether or not to expand Medicaid was summarily answered by the ACA – it was a given when the law was written.  It was only in 2012 when SCOTUS ruled that states couldn’t be penalized for opting out of Medicaid expansion that the complications and coverage gap issue arose.