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Debating the Fate of the Affordable Care Act

Former Maryland Governor O'Malley used Obamacare to make healthy reforms in his state; Professor Chirba co-wrote the guide to the ACA. What they had to say about the law's future prospects.


“All that we need depends on change,” former Maryland Governor Martin O’Malley said when he joined BC Law Professor and Obamacare expert Mary Ann Chirba February 6 for a discussion on the future of the Affordable Care Act (ACA) under President Trump.

The event was sponsored by BC Law’s Rappaport Center for Law and Public Policy, where O’Malley is serving as the Distinguished Visiting Professor this semester.

O’Malley, who oversaw improvements to Maryland’s health care systems while governor, stressed the importance of access to efficient health care throughout the country. Hospital care accounts for 40 percent of all health care costs in the United States, he said, a statistic that could continue to rise under the current federal administration. American health care has experienced an upward trend in cost amidst decreasing patient outcomes. This pattern contrasts drastically with the current state of most developed countries, which led O’Malley to challenge the audience: How can we do better?

Chirba, lead author of Health Care Reform: Law and Practice—A Comprehensive Guide to the Affordable Care Act and its Implementing Regulations, cited lack of public understanding and increased partisanship as key roadblocks to providing Americans with efficient health care. The Affordable Care Act has been branded in media and popular culture as “Obamacare,” often to the detriment of the law, Chirba said. Studies have shown that the vast majority of American citizens believe that each title represents a different health care program. With many individuals viewing the ACA more favorably in comparison to the polarizing Obamacare label, misinformation persists, she explained.

O’Malley called for a common sense approach to health care reform, embracing policies to increase quality of care while maintaining affordability.

He offered Maryland as an example. There, drastic improvements have been achieved through a shift in how health systems approach patient care, rewarding hospitals for wellness as opposed to hospital admissions statistics. By developing databases that allow for the exchange of patient health records among primary care doctors, specialists, and hospital systems across Maryland, quality of care has been placed at the forefront. Maryland has also contributed to decreased Medicare spending, setting rates for care at standard values throughout the state, he said. These initiatives have resulted in a decrease in repeat admissions and extended hospital stays as well as an even division of health care costs, eliminating the possibility of a “poor person” hospital and the diminished care that accompanies failing health systems.

The success of Maryland is rooted in the existence of the Affordable Care Act, O’Malley said, and with the ACA’s future hanging in the balance, both his state and the United States are at a health care crossroads.

Chirba noted that while the ACA policies are widely those of conservative leaders like President Richard Nixon, the Republican Party is searching for ways to rebrand the legislation and distance itself from Obamacare.

Recent statements from GOP leadership have indicated an interest in leaving intact provisions for coverage for individuals with preexisting conditions while repealing the bulk of the legislation. Chirba warned that these measures would have unanticipated consequences such as increases in health care costs.

She did, however, conclude her remarks on a hopeful note, saying that regardless of what happens to the ACA, it has established a new normal in the US. The Affordable Care Act will not be repealed without a replacement, she said, putting affordable and accessible health care at the forefront of our country’s priorities.

Photograph by Christopher Soldt, MTS, BC