Nancy Turnbull: Happy 10th Birthday, Health Care Law! But Now: Adolescence

One of a series of analyses on the 10th anniversary of the 2006 Massachusetts health care overhaul. Nancy Turnbull is a senior associate dean at the Harvard T.H. Chan School of Public Health. She has been a member of the Health Connector board since 2007.

Happy 10th birthday, Chapter 58. So far, you’ve had a pretty happy childhood:

  • Compared to when you were born, an additional 441,000-590,000 more people have health insurance. (We do need to get you some remedial math help so you can estimate the number more precisely -- you really should have mastered this equation by now.) This includes people in every group: women, men, young adults, elders and about 40,000 kids.
  • Coverage for people who qualify for subsidies here is much better and more affordable than in other states, and is a major factor in your success in expanding health insurance to so many people.
  • You celebrated the arrival of a sibling, the federal Affordable Care Act, and you’ve both learned to coexist without too much trouble (although the birth process did put the Health Connector’s website into the ICU for months and months).
  • As young kids must, you and the ACA have gotten used to being blamed unfairly for things you didn’t actually do (e.g., cause employer coverage to erode, create large increases in health insurance premiums).
  • Your parents and family still like you: Despite a variety of squabbles, skirmishes and spats, everyone who happily attended your birth is still talking to one another, glad that you were conceived, and proud of your accomplishments.

But now you’re moving into a more difficult period: adolescence. The time has arrived when you’re going to test the values that will guide or hinder your future development.

Maintaining good coverage and affordable premiums for people with low and moderate incomes is going to be one of your biggest challenges. Lots of other people in the family need resources that have been devoted to your development: education, housing, income support, transportation and other public infrastructure, to name just a few.

You have been immature, impressionable and sometimes downright petulant in your unwillingness to confront rising health care costs, and what really must be done to tame them.

Stop being unduly influenced by your younger cousins, particularly Chapter 224, and its youthful braggadocio. Do not succumb to the peer pressure from the kids in the “popular” and privileged crowd, who have their own interests at heart, not yours. Stop your lazy and regressive ways, and refuse to take the easy path of simply raising deductibles and other forms of cost sharing, and limiting provider choice, instead of doing the hard work of actually controlling costs. Befriend people who share your dreams and aspirations, your values and your desire to make your community healthier and more just, and will work hard with you on these ambitious goals.

Growing up is hard and you should take pride in all you’ve achieved so far in your short life. You’ve made life better, healthier and more financially secure for hundreds of thousands of people. So celebrate your successes.

But get ready for the challenges ahead: Being a tween is a wild ride!

Health Law Turns 10: What Analysts Say:



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