National health policy discussions for much of the past decade have been something akin to political warfare. Central to this policy fight: the Affordable Care Act, dubbed “Obamacare” by critics.
The tale began in President Obama’s first term, as the new administration considered his campaign pledge to dramatically reform America’s healthcare system and control escalating costs. With a Democratic majority in the House and Senate – and after much political turmoil – the ACA was adopted without a single Republican vote.
At the time, most non-partisan policy observers considered the ACA to be a moderate proposal, not unlike the program GOP Governor Mitt Romney had implemented in Massachusetts.
AzHHA never took a formal position on the ACA. This was before my time, but I’ve been told that –while our organization viewed features such as increased access to health coverage favorably – other components received mixed reception. In combination with the legislation’s lack of bipartisan support to sustain it over the long term, AzHHA opted to keep its powder dry.
Once enacted, however, we had a responsibility to advance those elements of the law that would help Arizonans. Our top priority: expanding Medicaid to bring health coverage to hundreds of thousands of Arizonans. Accomplishing this would require state action.
We called it Medicaid Restoration, as the effort was largely about restoring a state program that had been frozen amid deep budget cuts during the Great Recession. Following the leadership of Republican Governor Jan Brewer, AzHHA joined a broad, bipartisan coalition of healthcare and business interests. AzHHA even supported the extraordinary inclusion of a hospital assessment to help finance the program.
We now approach the 5-year anniversary of Medicaid Restoration, which was approved in summer 2013 and formally took effect on January 1, 2014. AzHHA has remained on the front lines of the effort to defend Medicaid Restoration in the courts and at the Legislature. Our legal action involved directly supporting the state’s defense of the hospital assessment funding provision, which the Arizona Supreme Court upheld last year. We also played a prominent and active role in stopping numerous efforts to repeal and replace the ACA, as proposed by President Trump and the new GOP-controlled Congress in 2017.
Below is an interview with AzHHA Presdient and CEO, Greg Vigdor, regarding the ACA repeal and replace efforts.
Our reasons for opposing these efforts were and remain pragmatic – not political. We fundamentally believe in improving access to healthcare for more Arizona patients and families. Each of these repeal-and-replace proposals posed a major threat to the coverage we helped attain for hundreds of thousands of Arizonans in 2013.
The November elections represented yet another moment of deep national reflection on the ACA and healthcare generally. Public polls indicated that healthcare and coverage protections under the ACA were leading issues for voters in the 2018 campaigns. Even candidates who had supported repealing the ACA took pains to explain that they support safeguards for people with pre-existing conditions. The results of the General Election further cemented that these and other key provisions of the ACA are now part of the expected healthcare landscape in this country. Voters won’t let them go without a fight.
Today, questions about how to cover, organize and pay for healthcare remain with us and will continue to be part of our near and long-term future. Already, somewhat vague concepts like “Medicare for All” are being invoked within the early framing of major issues for the 2020 presidential campaign.
It’s too early to know what shape this may take. What is clear to me is that it is time to put the political war over the ACA to rest. It was never perfect policy, but our responsibility remains as it has been since the law was enacted a decade ago: to make the most of the ACA in serving as a strong voice for patients and health providers.
That means focusing on how we can improve health coverage and fairness, while addressing healthcare costs that simply remain too high. On a larger scale, let’s consider how we can go beyond simply providing more healthcare to achieve the AzHHA vision of the Healthiest State in the Nation … and take more steps to improve the quality of that care and to reduce patient demand.
The slow political adoption of the ACA as an American health coverage program is not unlike the story of Medicare. The law passed in 1964 with some controversy and mixed public support, but now enjoys broad, bipartisan support from the public and among elected officials. Similarly, Medicaid initially lagged greatly in public favor and has now gained status as an essential health coverage program for tens of millions of Americans.
The ACA finds itself on a similar political arc: initial resistance followed by acceptance and, ultimately, support. In the spirit of the season, let us resolve that 2019 be the year we stop fighting about the ACA and, instead, see this energy devoted to the betterment of the patients, people and communities in Arizona.
Now that sounds like a worthy New Year’s resolution. Happy holidays!