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Honest Appraisal, Please

The New Physician January-February 2014

Though off to a rocky start, there’s reason to be cautiously optimistic about the Affordable Care Act and Despite consumers facing major problems with the website, it’s encouraging to see that over 2 million of them fought through the problems to sign up for health insurance.

To be sure, a lot still has to be done if the Affordable Care Act (ACA) is to ultimately prove a success. But that’s not what’s most worrisome. What is most troubling is the lack of honest dialogue about what’s been accomplished, what’s still needed and how the ACA is affecting real Americans.

For instance, Charles Gaba recently estimated that the ACA has provided health coverage to over 9 million Americans thus far: 2.1 million private; 4.3 million via Medicaid and CHIP; and 3.1 million for those under the age of 26 who can stay on their parents’ insurance. This is an important achievement. But an estimated 5 million more people could become insured if more states had participated in the Medicaid expansion that set eligibility to 138 percent of the federal poverty level, or about $27,000 for a family of three. But since the Supreme Court ruled the expansion optional in 2012, only 25 states participated as of October 2013, leaving millions uninsured because they suddenly fell into a “coverage gap.” This gap includes people who make too little money to qualify for federal subsidies but too much to qualify for their state’s Medicaid, an occurrence that has been disproportionately affecting minorities. According to the December 2013 Kaiser Family Foundation report, more than 1 million in Texas alone fall into this gap; 583,000 of them are Hispanic.

But there is also good news for Medicaid: In the states that have expanded, enrollment has more than doubled that of the private exchanges. This is a huge success, but why have we not heard about it?

Finally, and most troubling, is the plethora of stories floating around about the individual “victims” of the ACA. In one of the most commonly recited stories, published in the Fort Worth Star-Telegram, a 26-yearold’s premiums rose to more than $1,000 after the law was enacted. Opponents of the ACA, like House Speaker John Boehner, pointed to this story as proof that the ACA is creating more losers than winners. The only problem is that the story is full of inaccuracies. In reality, the 26-year-old’s premiums were only $350. This is not the only story that has been debunked. But even sadder is the fact that debunking the stories doesn’t seem to necessarily stop their propagation. In this case, the act’s fictional failures are far more salacious than its truthful successes.

The act won’t achieve the goal of universal quality health care on its own. I think that we can find a path to universal health care through the ACA, but it will require us to be open and honest about the ACA’s failures as well as its successes.

Dr. Nida Degesys is AMSA’s national president.