“So you consult in Healthcare…tell me, is ObamaCare dead?” Friends ask us this question so often that it make us realize a couple of things. First, with all of the politicking, actual changes, failed changes, and posturing, the ACA is more an enigma now than ever. Second, we need more interesting friends.

Since its passing in 2010, The Affordable Care Act (ACA), nicknamed ObamaCare, had been a lightning rod issue in the politics of this country. Whether you are a supporter or a detractor, there is no doubt that the ACA fundamentally changed health insurance in this country. That said, rather than focus on the hundreds of specifics changes, regulations, and modifications in the over 20,000 pages of the ACA, we will focus instead on the three overall goals of the law. We ask whether, despite the changes, the fundamental goals of the law remain intact. Three important goals were to:

  1. Make affordable health insurance available to more people.
  2. Expand Medicaid to cover more lower income adults
  3. Encourage innovative medical delivery methods to lower the cost of care

Let’s dive in to see what was accomplished and where we go from here.

I. Insurance Reform

Let’s start with insurance reform, which makes up the bulk of the regulations passed. We can think of the reforms as falling into a few distinct buckets.

  1. Make it easier for people who don’t get coverage through employers to buy it themselves by:
    1. Eliminating medical underwriting
    2. Limiting insurers ability to cherry pick only good risk through rating reform
    3. Eliminating pre-existing condition exclusions
    4. Providing subsidies to make it more affordable
  2. Penalizing people who don’t get coverage
  3. Make sure that smaller employers that offer health coverage offer coverage that meets basic needs
  4. Require large employers to offer coverage or face a penalty
  5. Ensure that the quality of the coverage is adequate by making sure that plans carry at least a minimum benefit level and that they cover things such as preventive services at no cost to the insured

The efforts to repeal the ACA in its entirety failed after several attempts but certain aspects of it have been peeled back. Provisions that prohibit insurers from refusing to cover pre-existing conditions are extremely popular and repealing or weakening those prohibitions have been off the table.

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