Health policy expert discusses the ACA

Sara Rosenbaum, J.D., a national expert in health policy and public health, provided insight into the Affordable Care Act (ACA) last week at a College of Public Health Grand Rounds.

In her presentation — titled “Implementing the Affordable Care Act: The Current State of Play” — Rosenbaum detailed the difficult political and legal course the ACA has gone through.

Sara Rosenbaum, J.D.

“We knew from our experience with President (Bill) Clinton’s Health Security Act that there would be a constitutional challenge to mandatory health insurance coverage,” said Rosenbaum, who has been named one of the nation’s 500 most influential health policy makers by McGraw Hill. “No law before has stated that people had to go into the marketplace and buy a service or product.”

Hurdles and implications

The ACA’s biggest hurdle was surviving a challenge in the U.S. Supreme Court that questioned the constitutionality of the individual mandate and the expansion of Medicaid.

In its decision issued earlier this summer, the court:

• Upheld the individual mandate that requires virtually all Americans to obtain minimum health insurance coverage or pay a penalty;
  
• Ruled in favor of Medicaid expansion, but with a critical exception — that each state has the option to participate.

Quick rejections

Rosenbaum said she was surprised that 15 governors immediately declared that they would not participate in the Medicaid expansion, noting that this is an issue that “deserves more thought.”

She cited a recent study developed by Jim Stimpson, Ph.D., director of the Center for Health Policy and associate professor in the College of Public Health. The study reported that expansion of Medicaid would yield huge economic advantages for Nebraska.

About the speaker

Rosenbaum is a professor of health services management and policy and founding chairwoman of the department of health policy at the School of Public Health and Health Services at George Washington University. She also is a former colleague of College of Public Health Dean Ayman El-Mohandes, M.D., M.B.B.Ch., M.P.H.

She has been recognized by the Department of Health and Human Services for distinguished national service on behalf of Medicaid beneficiaries. As a member of the White House Domestic Policy Council under President Clinton, she directed the drafting of the Health Security Act and oversaw the development of the Vaccines for Children program.