DrDanDerksen

Well at 906 pages, the Patient Protection and Affordable Care Act (aka the ACA or Obamacare) it's a little hard for individuals to sort through what's positive and negative. For example, there's almost $1 billion funded via an ACA provision for Prevention and Public Health. This allows funding through federal agencies like the Centers for Disease Control and Prevention (CDC) to grant funds to states for public health preparedness (for example to deal with Zika virus outbreaks), to education prescribing providers, individuals and families about the appropriate use of prescription opioids for acute and chronic pain, and for education programs to deal with our epidemic of overweight and obesity.

I see no upside to pessimism, so I remain hopeful that we can build on the gains made in coverage (i.e., reducing the uninsured to a record low of 8.6%), and focus on reducing the volatility of the individual health insurance marketplace. That won't be easy - but one thing that could be done is allowing insurers to sell plans across state lines, and making it so that the insurers can count on multi-year agreements to offer affordable plans on the state and federally facilitated individual marketplaces.

Cost opacity is a real problem, it's so hard to apply economic and marketplace strategies when so little information is available to consumers. Arizona passed a interesting bill making cost transparency more available to the public!

There are many countries with 'single payer' systems - though the universal coverage in one developed country can be quite different than another (e.g., Canada's might be described as along the lines of Medicare for all [not just for those age >65 as it is in the US], versus the system in Germany). Compared to other developed countries, the US spends far more (almost twice as much as other developed countries), yet in some important population health outcomes doesn't do as well (such as neonatal mortality, life expectancy). For what we spend (almost $10,000 per person in the US), we should be achieving better health outcomes.

This isn't just happening in the state of Washington! In Arizona, where I live, we had at least 7 insurers offering over 70 plans on our federally facilitated ACA marketplace two years ago - and this year we only have one insurer offering plans in each of our 15 AZ counties. Two years ago, we had the second lowest premiums for silver marketplace (healthcare.gov) plans - and from last year to this year, some of our counties saw a doubling of premiums. Those less than 250% of the federal poverty level were largely shielded due to the way the advanced premium tax credits work in the ACA - but those without subsidies certainly felt that jump. Congress can address this volatility in several ways - one important one would be allowing them to offer plans across state lines, another would be to allow multiyear contracts. This individual health insurance market needs stabilization - and the insurers are nervous, and the consumers unhappy with the jumps in premiums and that insurers are jumping in and out of the market each year.