A Balance of Shortcomings and Progress

Andy Skelton

By Andy Skelton, associate professor of psychology

Like most legislation, the Affordable Care Art (ACA) reflects attempts to balance competing economic, political, ideological and practical interests. Because the terms "equitable" and "efficient" are defined differently depending on those interests, the ACA falls short of being comprehensive or coherent.

However, it does end "pre-existing conditions" exclusions in private health insurance, expands to age 26 the coverage of adult children under parents' insurance plans and provides insurance payment subsidies for individuals and families in need. It also provides a unified rating system for private insurance plans offered in the exchanges, so individuals can more easily compare them. These are plusses.

We've managed as a nation to create social and medical insurance systems for the elderly and disabled. These were just as contentious when originally rolled out as is the ACA. I am concerned about deliberate attempts to sabotage ACA's rollout and some states'-including Pennsylvania's-reactions to Medicaid expansion. However, I hope better impulses will prevail.

Paul Starr's Remedy and Reaction: The Peculiar American Struggle Over Health Reform is a must-read for understanding the history of how we finance and administer health care in the U.S. and for getting details of how the ACA was developed, negotiated and passed.

Read more faculty commentary on the Affordable Care Act.

Published October 8, 2013