February 24, 2017
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As director of the Office of Health Reform at the U.S. Department of Health and Human Services under President Obama, Dr. Lambrew coordinated work toward the passage and implementation of the Affordable Care Act (ACA).
Most recently, she served as the deputy assistant to President Obama for health policy, with responsibility for ACA implementation.
Dr. Lambrew outlined three key points that she learned about health reform from working on the ACA:
- Real change is hard to design, enact, implement, and oversee. For example, the Obama administration held hundreds of congressional and other hearings even before proposing ACA legislation.
- Pragmatism needs to trump ideology, and compromise is often necessary. For example, President Obama actually did not favor the individual mandate but listened to experts when they showed him the data that supported it.
- The ACA is not a stand-alone piece of legislation but part of a complex structure that threads itself throughout the entire health care system. It would be very difficult to repeal it in its entirety, especially as that would dismantle reforms that have bipartisan support. For example, there are Medicare components of the law that are working well and will most likely endure even if there is a repeal.
Dr. Lambrew discussed her experiences in implementing the ACA and offered her opinion on the law’s future. She expressed hope that congressional leadership will keep parts of the ACA that everyone agrees are working, such as the Center for Medicare & Medicaid Innovation, which has had bipartisan support. However, she voiced concern over what an ACA replacement option might look like and how the markets would be affected in the meantime.
Ultimately, Dr. Lambrew sees the current political climate as an opportunity for innovation, although she has misgivings about the future. Audience questions varied widely in topic and scope, but one message was clear: uncertainty abounds.
Read a new report by Jeanne Lambrew and Ellen Montz that examines a little-known program in the ACA and its implications for high-risk pools going forward.