How Americans will take to the Affordable Care Act over the long haul may be hard to predict, but mapping out its future course need not be entirely the product of guesswork. That's because we have a model on which to base our predictions:
That's the conclusion of an article in the latest New England Journal of Medicine by Julie M. Donohue, a health policy expert at the University of Pittsburgh. Her main message: gaining public acceptance for a major program takes time.
"It takes a couple of years at least for people who are eligible for coverage to become aware of a program, to enroll in that program and to experience the benefits," Donohue says in a taped interview accompanying the article. "And until people experience the benefits of an insurance program, especially something that's new and a little different, the public opinion of that program may be relatively low."
More recently they attempted to liberalize those rules to give plans "more leverage in price negotiations" with manufacturers, Donohue says. But drugmakers, doctors and hospitals, and patients objected, and the change was dropped.
That shows how new programs create their own constituencies with an interest in the new status quo. For the ACA, that could be good news and bad news: it will build public resistance to cutbacks or repeal of the law, but may also hamper efforts to make it more efficient. "Because the ACA's impact on the health sector is even more far-reaching than Part D's," Donohue writes, "one can expect even greater resistance to changes to essential benefits or the generosity of coverage."
In sum, she says, "The headlines about Part D in 2005 and 2006 sounded an awful lot like the headlines in late 2013 and 2014 about the ACA."