The Affordable Care Act boasts a long list of accomplishments since it was signed into law by President Barack Obama in March 2010. It has driven down uninsured rates and health care costs and expanded coverage – 44 million people enrolled in health coverage last year through the ACA and Medicaid expansion.
Despite these successes and gains, the ACA faces a murky future. The federal budget bill making its way through Congress could upend ACA enrollment procedures and cut hundreds of billions of dollars in Medicaid funding.
Nancy-Ann DeParle, who served as the deputy chief of staff for policy in the Obama administration and played a key role in helping enact the ACA, discussed the act and the nebulous policy landscape surrounding it during a keynote session at AHIP 2025.
DeParle cited how the act has helped spur innovation and promoted value-based insurance design. “There’s always work to be done on quality and innovation, but I think we laid a strong foundation,” said DeParle, who currently serves as managing partner and cofounder of Consonance Capital Partners.
The ACA has also fostered innovation through state Medicaid expansion. Healthy Opportunities Pilots, data-driven programs in North Carolina that focus on nonmedical drivers of health such as access to food and primary care, were born out of that. The initiatives helped “make way for a bipartisan Medicaid space” in the state, said Mark McClellan, director of the Duke-Margolis Institute for Health Policy, who joined DeParle on the panel.
Now on its fourth presidential administration, the ACA has weathered myriad changes and challenges. So, what can be expected going forward? For starters, a movement toward prevention-based care.
McClellan, who served as CMS administrator and FDA commissioner under President George W. Bush, said Mehmet Oz, the current CMS administrator, is focused on “evidence-based prevention.” McCllelan added that scaling up value-based care programs — and finding a way to finance VBC across health plans — will be important.
DeParle, who cited concerns that the budget bill could be seen as “a big, bad backdoor repeal of the ACA,” said bolstering primary care so that it considers both medical and social determinants of health will be key. “That’s what we should be doing more,” DeParle said.
Tuffin tackles tough topics
AHIP President and CEO Mike Tuffin opened the conference with a keynote address that touched on several critical issues facing health care and health plans today. Here’s a closer look at what Tuffin said:
- On the budget bill: “We’re concerned that without some meaningful changes, some of what has been proposed could result in a meaningful erosion of coverage. So, we’re actively engaged in a fact based and substantive way with policymakers and partnering with stakeholders across health care, market by market.”
- On Medicare: “We’re really encouraged that Congress is keeping a clear promise that has been made to seniors: that there will be no cost to Medicare in the budget bill. As we move forward, we believe that discussions on the future of Medicare need to focus on the beneficiary. Let’s keep their coverage and care at the center of the discussion.”
- On health care affordability: “Broadly speaking, instead of putting coverage at risk, we really need the country to tackle affordability, tackle the root causes of high and rising health care costs.”
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