If you are a Republican chances are very good you say Obamacare (ACA) is a failure. If you are a Democrat you talk about its successes. The corollary is if you don't like Obamacare you are a Republican and if you like it you are a Democrat.
Which came first is like the chicken and the egg conundrum.
Obamacare is entering it's third year of transition. Some pundits have it as entering a holding area to be monitored as some of it's vital organ systems are struggling to survive.
The ACA was passed during a political firestorm, and a majority Democratic congress. The only people who knew what was written in the statute were those who wrote the actual Bill. Some prominent Democrats overtly expressed "you won't know what is in it until we pass it". Enough time has passed that we know that to be true, but we also don't know what is coming next.
The health landscape has changed dramatically in the past decade as has the economy. The calculus has changed in regard to reimbursement models and organizational stability.
Several things are happening that should set off warning bells (if congress even listens or cares) in the middle of world crises.
Politics and health care have been mixed,and patients now find their health is competing with ISIS, the war on terror and everything in the national budget. Physicians have always known and saw this several decades ago in 1963 when Medicare was added to social security entitlements.. As health expenses were met with an 80% coverage, and with the lack of cost containment medicare fueled health inflation. For more than two decades health expenditures grew at more than twice the rate of the gross domestic product, fueled by the black hole of the federal government and it's ability to manipulate budgets by borrowing and printing more currency. Now it is a part of the seventeen trillion dollar national debt. Annually health contributes to 17% of the GDP.
The ACA went into effect in 2013 and beginning then there have been enormous changes in health care financing, the administration and delivery of medical care.
Health insurance companies, health plans, and related enterprises such as pharma are adjusting to the limitations on profitability for operations.
Mergers and acquisitions have long been part and parcel of the health business scene. However the rate and size of the shifting health space has increased in numbers and size.
Health care business will survive in this hostile environment, as a necessity of life, the demand for services is infinite. The balance between restricting necessary health care and it's availability is precarious
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