Even the most ardent supporters of the Affordable Care Act likely would agree that there's still room for improvement when it comes to attaining the law's underlying goals of expanded access, reduced cost and improved quality.
Certainly, the law has brought the level of uninsured Americans to historic lows, accelerated the push to a value-based delivery system and given consumers a larger stake in the game, but there's variation in how those successes are playing out across the nation.
"The Affordable Care Act is still going through an implementation phase," says Ronald Williams, former chair and CEO of Aetna. "It has made progress in reducing the number of uninsured, but it hasn't made the progress we would like to see."
That's partly why the Conference Board's Committee for Economic Development today released its "prescription" for continued reform. Williams, along with former Merck President and CEO Raymond Gilmartin, co-chaired the subcommittee that developed the recommendations.
Central to the CED's platform is doing away with subsidies and giving everyone a refundable income tax credit. Williams, who spoke to me yesterday afternoon, said the ACA has built a foundation by expanding coverage, but it is time to examine other solutions to propel the system forward, particularly access and consumer engagement.
As most of you know, tax credits have long been bandied about in policy circles, but have failed to gain much legislative traction. Williams acknowledged as much, but contends that the ACA's method for administering subsidies and running exchanges is too complex and inefficient.
Not surprisingly, the CED report leans heavily on market forces to continue driving change in the delivery system, including expanded pay-for-performance concepts.
As the 2016 presidential campaign gets underway — and we await this summer's historic Supreme Court ruling — the CED report offers a glimpse into some of the policy debates that may come to the fore.
"Our intention is to have a debate on where we go in the future," Williams says. "We view this as a bipartisan, nonpartisan approach. Let's focus on what we can do to get the market to work better."