The Affordable Care Act of 2010: “Patches on a Patchwork”

Theodore Marmor gives Keynote Address at Health Care Policy Conference

HARTFORD, CT, April 29, 2013 – Theodore Marmor, the keynote speaker at Trinity’s inaugural health care policy conference, gave an unvarnished critique Friday of the federal Affordable Care Act (ACA), which will provide health coverage to tens of millions of uninsured Americans, including about 300,000 in Connecticut.

The law contains both good and bad elements, Marmor asserted, as he reminded attendees that universal health insurance – which arguably is what the ACA is, is not the same as universal health care. “Health insurance pays for some or all care. This [law] is, in many respects, a catastrophic health insurance policy for many persons.”

Marmor, professor emeritus of public policy and political science at Yale University and an expert on welfare state politics and policy, called enactment of the law “a very complicated episode in American public life,” and one in which President Barack Obama, unlike other chief executives, left it to Congressional leaders to hash out many of the details.

Marmor suggested that Obama badly miscalculated the role that Republicans would play, saying the president assumed the GOP would want to help shape the new law. In the end, Republicans refused to cooperate and the law passed without a single GOP vote in the House or the Senate.

Another complicating factor at the time of negotiation and passage was the economy, which was in free fall, spurred by the collapse of the housing market and the plunging stock market.

Marmor’s speech, “The Affordable Care Act: Separating Fact From Fiction,” highlighted Trinity’s first-ever Health Care Policy Conference, which also featured an appearance by Lt. Gov. Nancy Wyman and afternoon panel discussions dealing with Health Information Technology; Achieving Health Equity in Health Care Reform; and The Connecticut Health Exchange: Benefits and Challenges.”

​This academic year marked the introduction at Trinity of a master’s degree in public policy with a concentration in health care policy, whose primary focus is on the economic and ethical aspects of the delivery and administration of health care.

Wyman, who has been a longtime advocate for expanding access to health care for Connecticut residents and making it more affordable, said the administration of Gov. Dannel Malloy is excited about the ACA, also known as Obamacare, and will do all it can to ensure that state residents “know to sign up for it” and that the new health insurance exchanges will be workable.

Many supporters of the ACA believe it represents the most significant government expansion and regulatory overhaul of the U.S. health care system since the adoption of Medicare and Medicaid in 1965. When fully implemented, advocates say, the law will not only expand coverage to millions of Americans but hold insurance companies accountable; lower health care costs; guarantee citizens more choice; and ultimately enhance the quality of care for all Americans.

Already, the law has allowed young adults up to the age of 26 be insured on their parents’ policies and also barred insurance companies from excluding people who have pre-existing conditions from obtaining health coverage.

Marmor called the ACA “a mosaic of reform,” which tries to meld together the patchwork system in place today, one that consists of “socialized medicine” for veterans; Medicare for seniors; Medicaid for low-income Americans; commercial insurance offered through employers; and the federal law forbidding hospitals from turning anyone away.

Given the health care system’s many “patches,” Marmor said, about the best that Obama could do was “weave them into a quilt.”

Marmor was at times critical of Obama, arguing that the president overestimated the Republicans’ willingness to act constructively, and that there was no consideration given to a fallback position, such as reducing the age at which Americans would be eligible for Medicare or changing the federal tax code.

Marmor appeared skeptical as to whether the ACA will improve the overall health of the population or lower the cost of health care. And he cast doubt on whether the emphasis on disease prevention will “make a real dent in cost.” He claimed that almost “no serious student of medical care” believes that will occur, calling those claims “misleading and regrettable.”

In sum, Marmor said that Obama, in signing the ACA, “missed a great opportunity to frame universal health insurance as a moral right.”

Marmor was a member of President Carter's Commission on the National Agenda for the 1980s, and has testified before Congress about medical care reform, Social Security, and welfare issues, as well as being a consultant to the states of Kentucky, Delaware, Texas, Illinois, and Vermont, the U.S. Department of Health and Human Services, the Congressional Committee on Ways and Means, the Urban Institute, the President's Commission on Income Maintenance, the National Institute for Mental Health, the Office of Equal Opportunity, The Ford Foundation, and the Attorney-General, Canada.