The Affordable Care Act: The Value of Systemic Disruption

It is important to recognize the political and policy accomplishments of the Patient Protection and Affordable Care Act (ACA), anticipate its limitations, and use the levers it provides strategically to address the problems it does not resolve.Passage of the ACA broke the political logjam that long stymied national progress toward equitable, quality, universal, affordable health care. It extends coverage for the uninsured who are disproportionately low income and people of color, curbs health insurance abuses, and initiates improvements in the quality of care. However, challenges to affordability and cost control persist.Public health advocates should mobilize for coverage for abortion care and for immigrants, encourage public-sector involvement in negotiating health care prices, and counter disinformation by opponents on the right.It is important to recognize the political and policy accomplishments of the Patient Protection and Affordable Care Act (ACA),1 anticipate its limitations, and use the levers it provides strategically to address the problems it does not resolve. Passage of the ACA was a historic political achievement, breaking the logjam that long stymied national progress toward equitable, quality, universal, affordable health care in the United States. It has survived considerable challenges: a fractious legislative road to adoption in 2009 and 2010, more than 30 votes for repeal in Congress in 2011 and 2012, a Supreme Court case, and the national election of 2012. However, the benefits as well as the limits of this complicated law are poorly understood by the public,2 and opposition will likely persist. In part, this is because major provisions of the law have not yet been fully implemented, in particular the expansions of coverage through health insurance exchanges and Medicaid, although implementation will create other problems. In addition, the ideological and structural barriers to a more functional health care system have been weakened but not eliminated.