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ACA at Two: Already a Life-Saver, Cost-Cutter

On the even of the Supreme Court Ruling on the Affordable Care Act, Jonathan Cohn has a New Republic article calling attention to the impressive track record of the legislation --- even though some of it's key provisions have not yet kicked in. Cohn explains:

...Already more than two million young adults have gotten health insurance through their parents' policies...Millions of Americans have consumer protections that, for those unlucky to need them, have made a real difference in their lives.

Of course, it won't be until 2014 that we see the really big changes in health insurance coverage --the expansion of Medicaid to include everybody with income below 300 percent of the poverty line, the creation of a marketplace with subsidies where individuals and small businesses can get affordable insurance without discrimination. Undoubtedly this helps explain the public's ambivalence.

As for cost-containment, there are some compelling indications the ACA is working well:

The Affordable Care Act isn't simply about making insurance more widely available. It's also about re-engineering the health care industry, so that it operates more efficiently--providing treatment that is higher quality, less expensive, or both. Its primary means for doing so is a series of changes to the way Medicare pays for treatment. The idea, as Sarah Kliff explains in the Washington Post, is to move from a system that rewards volume (i.e., the number of procedures performed) to a system that rewards value (i.e., the quality of care provided).

...Medicare is actually saving money....Maybe the clearest sign of change is on the bottom line: Medicare spending has been coming in lower than projections.... Paul Ginsburg and Chapin White, two widely respected experts from the relentlessly non-partisan Center on the Study of Health System Change argue that slow growth explains only part of the change. Writing in the New England Journal of Medicine recently, they suggested the Affordable Care Act--and the incentives its putting in place--are a major reason Medicare is starting to save money.

Harvard's David Cutler, another highly respected economist, has been saying this was possible for a long time. "It is absolutely not just the recession," Cutler, who was an original architect of what became the Affordable Care Act, said via e-mail. "The ACA is having an impact, as are changes like greater cost sharing. There is a real question as to whether we are entering an era of low cost growth."

...More than five million seniors and people with disabilities have saved more than $3 billion on prescription drug costs, according to the Department of Health and Human Services....Highmark, a nonprofit insurer in Pennsylvania, is getting into the business of providing care directly through clinics of integrated medical professionals. Historically, such systems have provided some of the lowest cost, highest quality care in the country.

Cohn concedes that "it is far too soon to know the full impact" of the law, and adds "For now, though, popular health care remains a dream--even as successful health care reform starts, slowly but surely, to become reality." With such a promising beginning, an adverse Supreme Court ruling would be a national tragedy that does more damage to the health of Americans than any decision in the high court's history.