Has Healthcare Reform Failed?

October 25, 2016

By Kevin Mowll, Executive Director, The RISE Association

News articles announce retreats of large insurance companies from the public health insurance exchange markets, leaving many geographic areas served by only one insurance company option, and ask whether "Obamacare" is coming unraveled.  Other postings point to the financial losses that these companies have suffered.  Yet others observe the steep prices for insurance coverage that continue to rise while still leaving huge cost-share burdens on the backs of the unsubsidized enrollees covered by these insurance products.  Additionally, shortfalls in online enrollment levels are presented by some as further evidence of the failures of “Obamacare”. 

Others are disappointed in the stonewall of states refusing to expand Medicaid to low income populations as a solution to the uninsured problem and all that implies in terms of access to sorely needed healthcare for neglected populations.  Are we to conclude that the summation of all these woes means that healthcare reform is a failed experiment?  

Indeed, all of these symptoms are valid observations on the problems in the current HHS Marketplace, yet they are only one side of the ledger balanced against the many significant successes in rapidly moving millions of Americans under an umbrella of insurance.

While the motivation of some who disparage the program is ideological in nature, the one-sided view that ignores the successes is doing so because these critics would begrudge any wins achieved by their ideological foes.  Yet others settle for a negative verdict based on sound bites and thin insights. They fail to examine the root causes of the failure areas.  The cause of these failures is the foundational challenges posed by the way the U.S healthcare system and insurance companies work to begin with, not the marketplace reforms overlaid on top of that flawed foundation.  

In truth, we must first recognize that healthcare reform has barely started.  It has not yet failed nor has it succeeded because it is only recently begun.  Click here to continue



Tags: HIX

Log on to Your Rise Account

Forgot your password?
Create an Account

Association Sponsors

Latest Posts

Keep M.E.A.T. on Your List for a Healthy Audit

By Jeanmarie Loria, Advize Health, LLC If you’re reading this article, chances are you already know what HCC Coding is – but we’ll give you a refresher anyway. Hierarchical Condition Category (HCC) and Risk Adjustment Coding is a CMS-mandated payment model. This model works to identify those with chronic and other serious illnesses and prescribes a risk factor score to each patient, taking into consideration their ailments and other demographics. With every payment model comes a specific set of audit and review requirements that must be met to maintain the integrity of the system, and this is where MEAT (Monitor, Evaluate, Assess/Address, Treat) comes in handy. In a face to face visit M.E.A.T. maybe found in the chief complaint, history of present illness, review of systems, physical exam, assessment and/or plan....
Read More

Getting It Right: True North in Healthcare Reform

The movement to repeal and replace "ObamaCare" created so much political noise that clear thinking has been hard to come by. The 2010 legislation that created the marketplace for individuals and small business (the Affordable Care Act or ACA), has almost evolved into a political Rorschach test. The more that politicized options and alternatives to repealing, replacing, or repairing it were discussed, the harder it was to put into focus the original problems the legislation was designed to address. Nevertheless, the rancorous divisions over what needs to happen to fix problems in the individual insurance market remain a distraction from the real issue at hand: the cost of healthcare weighing down the economy and what we need to do to fix it. With all the intense debates swirling around this topic, an impression emerges that “solving the ObamaCare issues” is something that must be accomplished as an isolated matter, discrete and independent of other problems. The heated debates concentrate on the mechanics and tactics required to solve the "uninsured problem", the "under-insured problem", and for some, the federal budget problems created by the subsidies for low-income enrollees in these plans. This single-issue mono-vision obscures a reality that must be addressed. This perspective completely misses the fact that something is going on that is far more corrosive to the wellbeing of all of us as consumers of health care, as taxpayers, and as a nation: something that overshadows the tug ‘o war over ObamaCare. The critical and overlooked issue is that health care expenditures in the U.S are at least twice as expensive as other nations, which consume so much of the national economy...
Read More

Upcoming Conference


Qualipalooza: The 2nd Annual RISE Quality Leadership Summit 

This unique event incorporates three conferences presented side-by-side: the Star Ratings Strategic Planning Forum, the HEDIS Forum, and the CAHPS, HOS & Member Survey Forum. Register for one conference for an in-depth examination of a single area, or design your own event by opting for the all-access pass and choosing the sessions from each conference which correspond exactly to your interests.


Upcoming Webinar

Successful and Meaningful Techniques for Integrating Risk and Quality Interventions

Quality measurement and risk adjustment regulations are increasing and the financial impact upon health plans is progressively driving accountability and influencing profitability through payments, penalties, and bonuses. To improve performance and optimize risk and quality payments, Health Plans need to streamline processes, employ best practices for data capture, and focus on strategic interventions that use a member-centric approach.  

Connect With Us

Copyright © 2014 Resource Initiative & Society for Education. All rights reserved.