National Edition

Health care is no game, but will your family win or lose under Obamacare?

Published: Thursday, March 27 2014 5:30 a.m. MDT

Some shifts in the health care marketplace created by ACA are potentially friendly while others are hostile to innovations that could reduce overall cost of health care and make it more accessible to families, says a recent report from the Clayton Christensen Institute for Disruptive Innovation.

In a recent post on the institute's blog, executive director of health Ben Wanamaker observed, "In the noisy debate about whether the legislation is good or bad and whether to implement or repeal it, we think there’s something missing: a rigorous but practical discussion of the innovation opportunities created by the legislation and the barriers to innovation it imposes.” He’s referring to "disruptive innovation," a term Christensen coined to explain how new ideas or technologies can change demand enough to transform whole industries. CD technology did it to 8-tracks; mobile phones did it to landlines.

According to the study, which Wanamaker co-wrote, “Today, with health care costs spiraling ever higher, the U.S. is in a health care crisis — and in dire need of disruptive innovations that could make quality care more affordable and accessible.”

ACA policies that encourage such innovation include the rule that each person carries health insurance, “likely creating the need for new disruptive care delivery models at the low end of the market,” as well as the rule that businesses with 50-plus full-time employees offer insurance benefits, the report found. Accountable care organizations, wellness programs and a Centers for Medicare and Medicaid Services Innovation Center may also lead to innovation.

Other parts of the ACA discourage disruptive innovation, including minimum coverage requirements and the creation of exchanges where people can go online and find their own insurance. That’s “disruption-neutral.” The regulations pit marketplace newcomers against established companies and create a baseline that discourages innovation. Cost sharing and Medicaid expansion are not disruption-friendly, the report says.

Politics aside

There are so many rumors and perspectives, some families told the Deseret News, that they’re now simply confused. The situation isn't made easier by the personal stories freely — but not always accurately — shared by those who love Obamacare and those who hate it. Factcheck.org and reporters like Glenn Kessler at the Washington Post have been busily debunking stories or explaining overlooked nuances. Misrepresentations have originated on both sides of ACA.

That may not be surprising. An Institute for Family Studies blog recently noted a study published in the October American Sociological Review: “The authors, Clem Brooks and Jeff Manza, found evidence of recent increases in political partisanship, particularly with respect to government social programs. That is, attitudes regarding social programs like the Affordable Care Act are formed more by existing attachments to either the Republican or the Democratic party than anything else.”

ACA has fans, detractors and folks just waiting for the dust to clear. That may take awhile.

“This is not about whether Obama is an effective president or whether Congress and the president can get along. It’s trying to make access to health care more fair, more affordable for everybody — both the middle class that has it and worries about losing it and those who don’t have it,” said Nichols. He wonders whether people have forgotten the sometimes-painful road to implementing Medicare or its Part D prescription benefit.

Even Melanie Thomas and Lindsey Stephens won't know how happy they are with the coverage they purchased until they use it.

All over the nation, how well things work hinges in part on how states have set up their programs, UHPP's Stevenson said. Utah, for example, runs its own exchange for small businesses to get insurance, while the individual marketplace is handled by the federal government. Six health insurance companies have jumped in. Some states have one or two. Even in Utah’s rural areas, people have dozens of plans to choose from; in Salt Lake County, there are 91. Such competitiveness drives down costs.

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