Healthy reflections
Major conference examined lessons learned from the Affordable Care Act
Health care policy has become one of the signature issues faced by presidents of both parties—from the passage of Medicare and Medicaid in the Johnson administration through the implementation of the Affordable Care Act in the Obama presidency to the response to COVID-19 by Presidents Donald Trump and Joe Biden.
To mark the 10th anniversary of the Affordable Care Act’s implementation and the 14th anniversary of its passage, the Miller Center’s Health Care Policy Project cohosted a major conference on the law, also known as “Obamacare.” The March 2024 conference, held at Darden’s Sands Family Grounds in Rosslyn, Virginia, was a cross-UVA collaboration among the Miller Center, the School of Law, the Darden School of Business, and the Jefferson Scholars Foundation.
Love it or hate it, the Affordable Care Act remains one of the most significant pieces of federal legislation in U.S. history, and health care spending comprises the largest share of the federal budget.
The conference discussed the law’s greatest accomplishment: coverage. Millions of Americans have come to rely on the act to access affordable health insurance. Tens of millions more benefit from other provisions of the health law, such as protection for patients with preexisting conditions.
Americans today may take Obamacare for granted, but the road toward passage of the landmark legislation in 2010 was never smooth and its successful implementation was not assured.
Moreover, a 2012 Supreme Court ruling created room for variation among the states by allowing them to choose whether to expand Medicaid under the law.
The conference commenced with a keynote address by Nancy-Ann DeParle, former deputy chief of staff for policy for President Barack Obama and former director of the White House Office of Health Reform. It also featured Peter Orszag, former director of the Office of Management and Budget. Panel discussions included key figures from the White House, Congress, the Centers for Medicare and Medicaid Services, the Department of Health and Human Services, and the health insurance and hospital industries. President Obama himself sent a personal letter welcoming attendees.
An opening session examined the “strange bedfellows” coalition: a group of insurers, hospitals, pharmaceutical interests, reform advocates, and foundations that quietly met during the mid-2000s to probe the limits of what health care reform could accomplish and to build trust among key players.
As for passing the legislation, conference participants emphasized the importance of leadership, particularly from the president but also from key figures in Congress and the interest groups.
The necessity of planning for and funding implementation of the legislation represented perhaps the most important lesson of the conference. Problems such as the repeated crashing of the healthcare.gov website during the initial public launch might have been avoided with adequate testing and learning from the experience of states that had implemented health insurance exchanges.
Finally, most participants agreed that the Affordable Care Act is likely here to stay. Neither “repeal and replace” efforts promoted by some Republicans nor “Medicare for all” drives favored by some Democrats are likely to overcome interest group support for the existing framework or public reliance on its key features. One participant even argued that private insurance companies are evolving into a role analogous to that of public utilities that are privately held but that deliver critical public services.
These and other insights from the conference will be synthesized and published to share with key government officials, health industry leaders, and the public.
The conference provides a launching point for further development of the Miller Center’s Health Care Policy Project—in particular, focusing on how to address the rising costs of health care spending, even if the rate of growth has slowed. The ongoing policy project is coled by Guian McKee, White Burkett Miller Professor of Public Affairs, and Margaret “Mimi” Foster Riley, Dorothy Danforth Compton Professor at the Center and professor at the School of Law, with assistance from Vivian Riefberg, Darden professor of practice and David C. Walentas Jefferson Scholars Chair, who is also a Miller Center faculty senior fellow.