The voices of Urban Institute's researchers and staff
February 18, 2014

Can we have affordable health insurance without disrupting already-covered Americans? Not really.

February 18, 2014

Critics of the Affordable Care Act (ACA) want it both ways. They decry its disruption of health insurance coverage for those who have it, while asserting they too want Americans to have affordable coverage without regard to pre-existing conditions.

But we can’t have health reform without disrupting somebody. A good look at the ACA relative to alternatives demonstrates how modest – and helpful – its disruption really is.

In my latest brief, I explore how the ACA threaded the needle to minimize disruption of the already-covered, placing it in historical context and comparing it to reform alternatives.

The brief covers:

  • Why disruption is inevitable and how careful ACA designers were to minimize it;
  • How the ACA leaves employer-sponsored insurance (ESI) fundamentally unchanged for the 100 million people covered by large employers;
  • How the ACA targets its reforms to make broken insurance markets work for small businesses and individuals.

Yet even modest disruption encourages the belief that “there’s got to be a better way” to make insurance available, adequate, and affordable. So read on to consider:

  • How comprehensive alternatives to the ACA, coming from the left or right, would disrupt all or most of the 170 million people who rely on ESI and
  • How even modest measures touted as alternatives to the ACA’s market regulation would disrupt existing coverage that spreads health care risks.

No one likes disruption, but, relative to alternatives, the ACA’s disruption is modest in scope, cushioned by subsidies, and will benefit all participants over time.

Doctor's office lobby image from Shutterstock

SHARE THIS PAGE

As an organization, the Urban Institute does not take positions on issues. Experts are independent and empowered to share their evidence-based views and recommendations shaped by research.