As the United States begins implementing health reform, many aspects of the new law will be experienced differently depending on an individual’s current health insurance status. Joseph Newhouse, an internationally renowned Harvard economist, assessed health reform from the perspective of four different groups. He reports in a Health Affairs Web First article that the new law will probably reduce the number of uninsured Americans, but the steady rate of growth of health care costs is unlikelly to be curtailed absent further efforts.

The four groups Newhouse identified were those who are uninsured or eligible for Medicaid or the Children’s Health Insurance Plan (CHIP); purchasers of individual health policies and those insured through a small business employer; employees of midsize or large employers offering benefits; and Medicare enrollees. Although we can expect significant issues to arise concerning financing and administration, and perhaps the capacity of the delivery system, individuals in the first group will benefit greatly from the new law, Newhouse says. So will those in the second group, which he estimates could grow to become one sixth or more of the population.

Those belonging to the third group are generally unaffected by health reform at the moment, according to Newhouse. Those in the fourth group, Medicare enrollees, will gain from the law’s new benefits (especially concerning long-term care and the closing of the doughnut hole). But they also may find their access to care diminished; Newhouse warns that reduced reimbursement could cause some physicians to turn away Medicare patients who lack supplemental insurance or other means of making additional payments.

Ultimately, Newhouse observes, there is no panacea. The continually increasing costs of health care and Medicare, coupled with the lack of political will to increase taxes, will mean that the nation remains in a fiscal hole. “Despite all of the substantive and political problems of price setting, some sort of all-payer regulatory regime may be the only feasible alternative,” Newhouse concludes. “Health reform will accomplish many good things for a great many people.… But it is doubtful that the steps included in the Affordable Care Act to reduce the steady rate of growth of health care costs will suffice.”