With less than 11 months to go before most Americans will be required by the Affordable Care Act (ACA) to have health insurance, the law remains a deeply divisive mandate among both the public and the lawmakers who must decide how to implement it.
The common ground that might reasonably have been expected once the U.S. Supreme Court largely upheld the law’s constitutionality has not been realized, said Christina S. Ho, a health care policy expert who is an assistant professor at Rutgers School of Law–Newark. In a keynote address on February 5 at the Pharma Market Research Conference, Professor Ho discussed some of the reasons why such convergence has yet to occur and outlined one European country’s experience that suggests the potential for a transformed healthcare insurance landscape in the United States.
What seemed likely to bring stakeholders together on some common ground rules, said Ho, was the ACA’s encouragement of competition based on quality and value rather than risk selection. However, neither the federal government nor states have taken a muscular role in implementation thus far, thereby ceding to divergent state circumstances and health plan discretion. Much uncertainty still exists, with payers as the key stakeholders to watch, she said.
Professor Ho discussed the potential for convergence on a global-based evidence model, using the health insurance reforms implemented by the Netherlands in 2006 as her case study. Every country, Ho predicted, may drift toward coverage standards set by an increasingly global medical practice community. To ensure that innovation is accommodated, coverage needs to be designed according to an evidence-development model and not just an evidence-based model, she added.
Professor Ho is a graduate of Harvard’s John F. Kennedy School of Government and Harvard Law School. She was a member of the White House Domestic Policy Council during the Clinton Administration and later led Senator Hillary Clinton’s health policy legislative staff.