Political Machinations and the Affordable Care Act

This paper, part of a panel addressing the historical background to the Affordable Care Act (ACA), examines the political machinations and background to the legislative process which produced the law.  The affected constituents – physicians, hospitals, payers, drug and device manufacturers, medical schools, allied health professional – were included throughout the process legislative process, which was run wholly through the legislative committees. The White House, while offering general encouragement to the process, and setting broad desired parameters to the new law, stayed largely out of view.  The final compromise, reflecting scaled down expectations for cost controls and no public payer option, passed by the narrowest of votes (the U.S. Senate had lost it’s filibuster-proof majority in a special election that fall to fill Edward Kennedy’s seat) which excited no one, but at least marginally pleased many.

The paper looks at the both the immediate effects of the new legislation as well as potential long-term consequences, and analyzes it for its legality (two years later it survived a major constitutional challenge in a split Supreme Court ruling), its failings, and its potential successes.  Certainly fewer Americans will lack health insurance in a post-ACA world, but many will be nearly impoverished by the premiums they are now mandated to pay, and few of the broader complaints about the U.S. health system, ranging form over-specialization to over-capitalization, will be addressed.