Professors Say Shutdown Debate Could Change Perceptions of ACA

Following the debut of the Affordable Care Act’s health exchanges on Oct. 1, Harvard academics in health economics and public policy suggest that the Act’s role in the government shutdown on Tuesday might affect the way the public views the reform plan.

“The ACA is the law which will dramatically expand the ability of most American citizens and legal immigrants to obtain affordable and quality health insurance coverage,” said John E. McDonough, who worked on the writing and passage of the health law in the United States Senate from 2008 to 2010 and is now director at the Harvard School of Public Health’s Center for Public Health Leadership. “The Republicans in Congress are attempting to use the non-funding of the government to gain political leverage in trying to defund or stop implementation of the law.”

The Patient Protection and Affordable Care Act was signed into law by President Obama in March 2010 and includes Medicare expansion in some states and nationwide insurance exchanges—online marketplaces where individuals can browse, compare, and buy health insurance plans. Under the Act, individuals are required to buy health insurance by Jan. 1, 2014, or pay a tax for non-compliance.

Benjamin D. Sommers, assistant professor of health policy and economics at the School of Public Health, took leave from Harvard in 2011 and 2012 to evaluate the efficacy of the health care program at the Department of Health and Human Services. He called the online marketplaces “an Expedia or Kayak for health insurance,” and cautioned against letting policy and politics too heavily shape their future.

“What I would hope as both an academic and just as an American citizen is that we could get this out of the realm of the purely political,” said Sommers. “Right now it’s pure political theater.”

The exchanges were launched on Oct. 1 despite Republican protestation. Glitches due to immense site traffic marked the debut of state and federal-run marketplaces.

“I think it is not surprising that there are early logistical glitches in the ability of people to get information about health insurance exchanges and to sign up through these portals given the complexity of insurance offerings and the mechanics of figuring out subsidies,” said Katherine Baicker, professor of health economics at the School of Public Health. “I certainly hope that those will be ironed out sooner rather than later because it is important that people get accurate information and are able to make informed decisions about the plans that are available to them.”

Though preliminary statistics about enrollment have already been released, some academics have suggested that it is too early to understand their long-term implications. In fact, future decision-making on health care will be largely driven by public opinion, according to Robert J. Blendon, professor of health policy and political analysis at the School of Public Health.

“As we’re shifting from a public policy debate, what is going to change opinion is not something the President says or the government says,” he said. “A year from now, it becomes like buying a consumer product: it’s real, it’s on the market, your neighbor will have enrolled, will have tried, and will have used the card. People’s opinions are not going to be shaped by some general view, but by what actually happens and what they see and hear from these plans.”

—Staff writer Fatima N. Mirza can be reached at Follow her on Twitter @fatimanmirza.