In the 26 months since its passage, the Patient Protection and Affordable Care Act, commonly called “Obamacare,” has revolutionized healthcare and insurance practices across the nation and triggered rancorous political debate. Although most of its provisions have yet to take effect, both health care providers and employers have scrambled to comply with the requirements of the act by the time each requirement becomes operative within the next few years.
But for Harvard, the act does not spell chaos or upheaval. In fact, Harvard’s own healthcare services and insurance programs will hardly require any retooling at all, because the University is already in compliance with Massachusetts’s 2006 healthcare reform law, which overlaps substantially with the act.
Nevertheless, the act has provided an opportunity for students and researchers at Harvard to examine existing healthcare regimes and the state of public health in the United States, shedding light on the flaws and advantages of the sweeping reforms ushered in by the Affordable Care Act.
AHEAD OF THE CURVE
Since the Affordable Care Act was signed by President Barack Obama, it has implemented policies aimed at reducing costs and increasing care for seniors, preventing discrimination against individuals with pre-existing conditions, expanding coverage for young adults, and lowering healthcare premiums.
During the height of negotiations, John E. McDonough, a professor of public health practice at the Harvard School of Public Health, was in the eye of the storm. While assisting the Senate from 2008 to 2010 as a policy adviser, McDonough helped to fine tune the act in the run up to its passage in March 2010.
McDonough describes the goal of the Affordable Care Act as striving to create “comprehensive reform of the U.S. health system, to improve access to health insurance, to improve the quality and efficiency of medical care, and to control the rising rate of healthcare costs.”
Next year, the act will provide more funding for state Medicaid programs and children’s health insurance. In 2014, the act will eliminate annual limits on services, provide tax credits, and mandate individual coverage. In 2015, it will tie physician payment to quality of care.
For many institutions across the country these changes will require considerable administrative reorganization. But for those based in Massachusetts, the required changes will be relatively minor.
The Massachusetts healthcare reform law, enacted by former Massachusetts Governor Mitt Romney in 2006, improved access to health care by creating a state-operated health insurance exchange and providing subsidies for middle- and low-income individuals. It also required all adult residents of the state to have insurance. Compliance with this existing law has allowed for a smoother transition to the Affordable Care Act for employers and healthcare providers across the state.
Michael E. Chernew, professor of health care policy at Harvard Medical School, described Massachusetts as already “far down the road” in complying with the Affordable Care Act requirements.
“Whatever one thinks about the Affordable Care Act, it is probably less relevant to Massachusetts,” Chernew says.
By virtue of its geographic location and its previous policies, Harvard also is far down the road in terms of compliance, steering clear of most of the reorganization that will take place at many other healthcare institutions.
CHECKING THE BOX
Although many Harvard students have engaged in heated debates about the act, they are unlikely to be directly affected by the legislation in their capacity as Harvard students.