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What Does October 1 Mean To Health Reform?


September 27th, 2013

October 1, 2013, is not the most important date in Affordable Care Act implementation history. The most important date is November 4, 2014, when the next members of the House of Representatives and 1/3 of our senators are elected or re-elected. The nation’s collective judgment about the ACA will be on the ballot then even more than it was in the Presidential election year of 2012 and will be again in 2016.

October 1, 2013 is an important milestone for the progress of health reform, for it ushers in a new era of insurance market rules, rules that are considerably more in the consumer’s favor. Not completely, and not costlessly, but more in the consumer’s favor than ever before. For the first time in our nation’s history, insurers can neither refuse to sell to someone with an existing health condition nor charge them more than a perfectly healthy person of the same age. For the first time in our nation’s history, lower-income working people without access to tax-subsidized employer-sponsored insurance (which most people reading this blog post have) will be eligible to buy relatively comprehensive insurance at relatively affordable prices (by all accounts at least some premiums in every market are way lower than feared and actually cheaper than a typical group policy today), due partly to the competition engendered by the new market rules and partly to new income-based subsidies.

For the first time in our nation’s history, a combination of federal and state policies (in some states) will make it possible for every American citizen to afford decent health insurance and thereby greatly increase equity in access to quality and effective care, which should ultimately enable us to abolish the fear of financial ruin from out-of-pocket health costs and to become a healthier nation. These are all very big deals in the evolutionary improvement of our democratic republic.

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Is Health Reform Fiscally Responsible?


April 20th, 2012

Editor’s note: On April 10, Charles Blahous released a paper on the fiscal consequences of the Affordable Care Act. Below Len Nichols responds to the arguments Blahous raised in the April 10 paper and offers his own views on the ACA’s fiscal consequences. In related Health Affairs Blog posts, Paul Van de Water responds to […]

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State Of The Union: Let’s Be Honest For A Change


January 26th, 2011

Editor’s Note: Below, Len Nichols, Professor of Health Policy and Director of the Center for Health Policy Research and Ethics at George Mason University, discusses President Obama’s State of the Union address and House Budget Committee chairman Paul Ryan’s (R-WI) Republican response. See other posts on this topic by Kavita Patel and Joseph Antos.  In last night’s State […]

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Reforming Medicare’s Governance To Enhance Value-Based Purchasing


March 20th, 2009

With the release of the Medicare Trustees’ report for 2009, the worsening economy, and the continued high and rising cost of health care, many are anxiously awaiting a credible plan to reform the Medicare program and the health system as a whole. As Peter Orszag and others have argued persuasively, the ever-growing cost of health […]

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In Obama Reform Push, Medicare Leads The Way


February 27th, 2009

President Barack Obama opened his speech to Congress on February 24 calling for our nation to take responsibility for its future once again and finally face our long-term challenges, including our structural fiscal imbalances. He was clear that we will no longer ignore the challenge to reform our struggling health care system, nor will we […]

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Covering The Uninsured: Calculating The Cost


August 26th, 2008

Editor’s Note: This post by Len Nichols of the New America Foundation appears in tandem with yesterday’s publication on the Health Affairs Web site of an article by Jack Hadley of George Mason University, John Holahan of the Urban Institute, and coauthors, which estimates the cost of covering uninsured Americans.  Additional bloggers on the Hadley-Holahan article include Henry Aaron of […]

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