2013 Sets Stage for Affordable Care Act

With 2013 upon us, President Barack Obama’s signature legislative achievement – the Affordable Care Act – is quickly moving from the realm of controversial politics to basic, accepted reality. Most provisions of the contentious health care law will go into effect one year from now, on January 1, 2014. But that means this year is a crucial one in setting the stage for a transformed health care system – in Illinois and states across America.

On Chicago Tonight at 7:00 pm, we talk with Michael Millenson, a national health care consultant who blogs about health care for Forbes. Millenson also covered this topic at the Chicago Tribune, where he was nominated three times for a Pulitzer Prize.

Illinois is a particularly important testing ground for the Affordable Care Act because of the state’s massive uninsured population, one that numbers around one million people. (Illinois joins California, Florida, Georgia, New York and Texas as one of the six states with the highest numbers of uninsured people in the country.) In Cook County alone, one in five adults does not have health insurance. But that number will shift next year, as the ACA mandates that all people access health care of some kind, or else face a tax penalty.

For Millenson, expanding the pool of insured people will have a profound effect on how the system as a whole functions. Health providers, he says, will have no choice but to be “more responsive to patients’ needs and values,” as consumers will suddenly have more choice in where they can go for basic care.

“By giving everyone an insurance card, we upset the apple cart,” Millenson says. “All of a sudden, the people at community health centers can go anywhere for care. Thus, these community health centers have to be different. Meanwhile, these centers can attract patients who used to go to hospitals. There will be more mobility for patients.”

Here in Illinois, Gov. Pat Quinn’s administration is racing to meet federal deadlines. In particular, the state is partnering with the federal government to set up a system of insurance exchange from scratch. Insurance exchanges are online marketplaces where individuals and businesses can shop for health care plans, and low-income people can claim government subsidies. Having decided it would be too challenging to meet the federal timetable for implementation, Illinois is pursuing a state-federal partnership for its insurance exchange. (Though the state aims to have a fully state-run exchange two years from now, in 2015.)

For Millenson, the conversation on implementing the ACA often focuses too much on these technical aspects rather than the deeper, behavioral shifts in how health care will soon be delivered.

“So many times, the changes are talked about in a technical aspect; for instance, insurance cards and tax penalties,” he says. “But what we’re seeing is an enormous cultural shift in health care. We’re only just starting to figure out what it’s going to be.”

At the end of the day, Chicago and Illinois carry symbolic value in the implementation of health care reform, Millenson says. After all, this city is President Obama’s home turf, now led by his former Chief of Staff, Mayor Rahm Emanuel. It’s also, in some ways, the birthplace of President Obama’s relationship with health care reform. From 2005 to 2008, Michelle Obama worked as Vice President for Community and External Affairs for the University of Chicago Hospitals, a position she left during her husband’s first presidential campaign.

“We have a president who has this personal experience with health care, quality and transparency,” Millenson says. “His wife worked for a hospital system. This couple knows Chicago and Illinois health care. It’s important, in Illinois, to show that this can work.”