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What’s Next for the ACA?

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Laura Caccioppoli 
September 6, 2016

The conventions may be over, but the presidential debates are about to begin and one topic will surely come up: The Affordable Care Act (ACA). Hillary Clinton has a long history of fighting to improve health care, including her role in creating the Children’s Health Insurance Program. She has vowed to defend the ACA and improve it. Donald Trump, however, wants to repeal the ACA.

Hillary Clinton is right in defending the ACA. Prior to the ACA being enacted; a 2008 Gallup Poll showed that 14.6 percent of adults over the age of 18 were uninsured, by the beginning of 2014 that number had risen to 18 percent. In 2016, Gallup polls show that only 11 percent of adults were uninsured and the Centers for Disease Control puts that number at about 9.1 percent. Many people would call that a “yuge” decrease in the number of uninsured adults. Donald Trump, and the Republicans, see it differently. And they are also right.

Unfortunately, it hasn’t been all wins for the ACA. The administration had hoped the ACA would drive private insurance companies to the marketplace, causing competition to lower costs and allowing for consumers to have options. Obviously, this did not happen. In fact, in some states, there is only one option on the marketplace. In Arizona there is a county that may have no subsidized insurance next year. A lack of options, a less affluent demographic and insurers pulling out of the marketplace – that’s not good.

The Affordable Care Act failed to deliver for liberals who saw it as an opportunity to tackle rising premiums and take on big pharmaceuticals. On a personal note, I know this to be true. A year into dating my now fiancée, she developed optic neuritis which causes numbness and tingling in her legs, extreme exhaustion. After body and bank account were pricked and prodded like a pincushion, we had an answer, multiple sclerosis. Her neurologist started her on an intravenous immunoglobulin (IVIG) treatment, which required her to sit in a chair for almost six hours while someone else’s white blood cells were infused into her body (a testament to medical advancements). She felt great until her insurance decided to deny her additional IVIG – apparently she didn’t need it. She also used an immunomodular drug which was an injection, but after she (as a medical professional herself) became noncompliant, switched to an oral medication. Most recently, her insurance changed specialty pharmacy providers and didn’t tell her. When she tried to refill her prescription, she couldn’t. One week and counting without meds.

But enough about me. You may have heard that the CEO of Mylan, the makers of the EpiPen, raised the price of this life-saving pharmaceutical by more than 400 percent. As a refresher, the EpiPen is used to treat anaphylaxis, a severe allergic reaction which may cause death. Hillary Clinton called the price hikes “outrageous” and while Donald Trump has remained silent on the issue, other Republican lawmakers have expressed outrage.

Unfortunately, these price hikes are not unusual. In fact, Martin Shkreli (founder of Turing Pharmaceuticals and famous smirker) notoriously raised the price of a medication used to treat both AIDS and cancer from $13.50 to $750. Generics are not exempt either. In perhaps one of the most egregious instances, Doxycycline Hyclate (an antibiotic) jumped from $20 in October 2013 to $1,849 by April 2014 – an over 8,000 percent increase! Both Republicans and Democrats are outraged.

So despite my fiancée’s experience and medication price hikes, there is a silver lining. There is now an opportunity to bring a moral component to the debate. In my opinion, one of the biggest ACA successes was that those with preexisting conditions could no longer be denied insurance. Republicans agree. House Speaker Paul Ryan released a nearly 40-page list of Republican policy ideals, which included preventing insurance companies from denying those with preexisting conditions.

Repealing the ACA in its entirety would be difficult and politically unwise. As noted, many Americans now have insurance and more importantly, are using it. Despite an increase in premiums, many experts believe insurance premiums would be even higher without the ACA.

But we aren’t Switzerland or Germany. Implementing a system with private health insurance providers and universal coverage would be difficult. After all, the U.S. is massive with a diverse population, varying health needs by geographic region, etc. European countries have also had better success in enforcing their individual mandates.

In 2017, we have a unique opportunity to utilize Section 1332 of the ACA, or State Innovation Waivers which would allow states to “waive” certain components of the ACA, allowing for states to experiment and better serve the unique individuals living in their states, while maintaining strict standards (read more here). But we can only have success if we as a country can collectively remember the disgust we felt at Mylan and Turing for their price gouging. If we remember that health care is about our fiancées, families and friends, and combine that with Section 1332, we could make some great strides.


Author: Laura Caccioppoli is a millennial and doctoral student in health policy at University of the Sciences. She has an MA in political science and a graduate certificate in nonprofit management from Villanova University. Laura serves on the board of The Consortium in Philadelphia and Americans for Democratic Action, Southeastern Pennsylvania Chapter. Her research interests are in health and food policy, cultural competency and social justice.

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