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The ACA’s Seven Year Itch: Repeal, Replace or Repair?

hs44Guest Post from Deborah L. Benzil, MD, FACS, FAANS (left)
Vice President, AANS
Chair, AANS/CNS Communications and Public Relations Committee
Mount Kismo Medical Group
Columbia University Medical Center
Mt Kisco, New York

Clemens M. Schirmer, MD, PhD, FAANS, FAHA (right)
Vice-Chair, AANS/CNS Communications and Public Relations Committee
Geisinger Health System
Wilkes Barre, PA

ocOn March 23, 2017, the Affordable Care Act (ACA) turns seven, and just two months after the inauguration of Donald J. Trump as the 45th president of the United States, its future is largely unknown. The ACA was signed into law by President Barack Obama on March 23, 2010, and represents the most significant change to the U.S. health care system since the passage of Medicare and Medicaid in 1965. Despite this, according to a recent Morning Consult survey, one-third of Americans don’t know that ObamaCare and the ACA are the same thing— with late night talk show hosts often lampooning this problem. This finding alone highlights the need for increased public education on the topic.

It is for this very reason that over the next month Neurosurgery Blog will do a deep-dive into the ACA and efforts to improve a law that many viewed as deeply flawed. The goal will be to educate, inform and pose critical questions that need to be addressed so patients can get the care they need, when they need it, by the medical professional of their choice.

Coverage, Choice and Cost

The idea behind the ACA was to give more Americans access to affordable, quality health insurance and to reduce overall health care costs. Proponents of the law also sought to transform the health care delivery system to achieve better health outcomes. Right now, the rhetoric on both sides is bold and loud, as policymakers battle over the ACA’s future — largely viewed through the lens of what has happened over the last seven years. As the health reform 2.0 debate unfolds, organized neurosurgery will assess any changes to the law on three fronts:

  • Expanded insurance coverage;
  • Enhanced choice of insurance plan and providers; and
  • Lower health care costs.

Whether the ACA has adequately met these goals is sometimes in the eye of the beholder, but by most objective measures, the promises of the ACA have fallen well short. Consider the following:

  • 20 million more Americans have health insurance today (although most of this is through Medicaid). Yet nearly 30 million continue to lack coverage.
  • Insurance market reforms — such as coverage for pre-existing conditions and guaranteed issue — provide critical consumer protections. However, because not enough young or healthy people have purchased insurance, ObamaCare is in a so-called “death spiral.”
  • Health insurance premiums remain very expensive for most, and annual double-digit increases are not uncommon. Additionally, consumers face significant out-of-pocket costs with annual deductibles of $5,000 to $10,000 in some cases.
  • Keeping your preferred physician or insurance plan is not always possible, and insurance practices such as “narrow networks” further restrict choice and access.
  • Insurance markets have become less competitive. Critical analysis delineates that compared just to last year, competition among health plans is scant. Many states have seen a reduction in the number of providers, and 32 percent of counties now only have one insurer.
  • Insurers continue to drop out of the ObamaCare marketplaces, and recently Humana, the third largest health insurance in the nation, announced that it would withdraw from the individual insurance market in 2018, citing, “further signs of an unbalanced risk pool.”

Of course, for individuals with preexisting conditions and health problems requiring ongoing care, the ACA has been a godsend. The same goes for Americans that have received financial assistance for insurance premiums and other cost-sharing subsidies.


It’s hard to say what the future holds for changes to the ACA. As we write this blog, lawmakers, Americans and the media continue to debate the consequences of repealing, replacing or repairing the law. It is no surprise that the ACA’s seven-year itch is revealing some good, some bad and perhaps some unmentionables. Will it survive and if so in what form? The one thing we know for sure is the goal of Neurosurgery Blog’s health reform month is to honestly and directly confront the important issues regarding the ACA, focusing mainly on how they impact the neurosurgical community and our patients. America’s neurosurgeons strongly support improving our nation’s health care system, including expanding access to affordable health insurance coverage for every American.

We have a lot in store for our readers in the coming weeks, and we hope you join the conversation online by using #HealthReform.

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