51:4 Putting Insurance Reform in the ACA’s Rear-View Mirror


This Commentary acknowledges and applauds efforts to understand the mechanisms of insurance reform contained in the ACA and to evaluate their success or failure. But the Commentary’s principal purpose is to examine the pros and cons of connecting insurance reform to health care and health—the pen and the french fry—and to convey the importance to the country of moving beyond insurance reform as quickly as possible. The Commentary begins by describing the potential synergies among the three health policy domains and offering reasons why the ACA sought to make simultaneous changes. It then identifies the vulnerabilities that are revealed in the Act’s combined approach. It concludes with a few observations about ways of improving both health care delivery and health, while expressing the hope that the ACA’s indisputably sweeping ambition will not be its downfall.