ACA and AHCA: Don Berwick Breaks It Down

© 2021 Institute for Healthcare Improvement.

Health care has taken center stage in the last few months in the United States. From debates on Capitol Hill, to town hall meetings, to non-stop media coverage, topics like insurance coverage, Medicaid expansion, and payment reform have been on everyone’s minds.

No matter your view, we believe a common understanding of the issues is critical.

It is in that spirit that we share this video from Dr. Don Berwick. Berwick, President Emeritus and a Senior Fellow at IHI, explains the changing health care landscape in terms that are both simple and comprehensive. What’s the future of the Affordable Care Act? If it’s “repealed and replaced” by the American Health Care Act, what will change? What's the difference between the two?

Berwick originally gave a version of this lecture at a Leadership Alliance Meeting in May of 2017. Reactions from Alliance members encouraged us to share it more widely. We — and Don — hope you find it helpful:

[katelyndunn]

Thank you! I'm a senior in college writing an essay on the ACA and this made more sense than my professors and many other sources online. A great gift to an overwhelmed student in 2020 :)

[Hopeofsuns]

update again please, sir!! for 2019-2020

[kathleengould]

Wonderful explanation. Everyone must take the time to listen and understand this important topic

[wvldent]

Excellent Presentation. I retired in 2010 as CEO at a FQHC and was heavily involved in the lead up to the ACA. Since we were in a high poverty area we were vitally concerned about providing coverage to the low income population/ The ACA was a god send for us and other community based health care organizations. The constant drum beat of a repeal and replace is pure fantasy and will only serve to make life harder for millions of low income people, and make it harder for providers to actually provide care in low income areas as well as health proviider shortage areas. I am writing this comment in June 2024 so hopefully Biden and his team will be re-elected so that the ACA can be expanded and improved. Thank you for your informative explanation.

[kristofferward]

Everybody I know pays double or more premium, higher deductable and often less coverage since ACA.

[anitamurcko]

Fantastic explanation...wondering if would consider an update?

[risfg]

Well explained. Consistent with the readings I've done for this class I'm taking.

[theKurtAnderson]

I've surveyed a /bunch/ of video summaries on the ACA and this one is definitely my favorie. Thanks!

[barbsmall]

I think you are also missing the point for the people who now have to pay their premiums we can not afford to pay. We are essentially picking up the tab for all the people who are getting their coverage for free. The Deductibles are now the maximum out of pocket so the insurer is not paying a dime until you have paid your maximum out of pocket, but are charging extravagant premiums. You were way to one sided on your topic. There are huge issues with the ACA for the premium paying public. Paying upwards of 700 a month and then still having to pick up the full tab when you go to the doctor why have insurance??

[MiguelinaAriasMIA]

Provide money to people who does not have enough money and charge more to those who have enough. Got it.

[Squirrelbear]

Very helpful and informative. Do an updated one and one on single payer and universal healthcare

[rclines]

I like how all the good doctors are leaving the ACA. Just had my PCP AND ENT both leave this year because of issues with payments last year. Now I have marketplace insurance that is useless to me.

[kennyw]

What I don't understand is the lack of emphasis
on preventative health care and education. Consider this: the average cost for
a coronary bypass is ~$75, 000. Now that people are living longer, patients are
returning for their second and third bypass procedures! We learned from the
Framingham Heart Study that heart and vascular diseases are not only
preventable, but reversible in most cases. That's right, patient’s that did not
alter their lifestyles, needed repeat bypass procedures. The same is true for
preventing strokes, diabetes (Type II), hypertension, obesity and lung cancer,
not to mention the morbidity associated with inflammatory joint diseases. What
exactly am I referring to? Education on the proper amounts and types of
nutrition, exercise and smoking cessation. These are the leading causes of preventable
morbidity and death in the western world. You do not need a PhD in economics to
see that prevention is far more cost effective than intervention. I guess you
don’t need a PhD to work for an insurance company either, since they, with the
support of the GOP, want to abolish preventative health care services out of
the so-called American Health Care Plan. Thank you, Dr. Berwick.

[paulr]

How's canada's health care going? People their are waiting 6mo plus for cancer care, surgeries etc.. they are passing away waiting for surgeries.

[johngreen]

It's like saying help my neighbor pay for his kids. I don't think I received that conversation when I was younger that I would be responsible for people I didn't know.

[rickstanford]

He failed to mention that a byproduct of the ACA was to push the door wide open for employers to provide limited or no more employer healthcare benefits, thus forcing many of the working class and middle class “workers” into the exchanges where the exorbitant prices (due to ACA driven community rates) made our insurance UN-affordable, while we foot more of the bill for others (being subsidized by US and the Government - via more of our tax dollars). I’m not advocating for less fortunate folks to not have healthcare but I am extremely outraged that the government driven changes jeopardized/eliminated what little affordable healthcare we had previously and then shifted it to someone else... leaving us with the “unaffordable” care!

[slobnoxious]

Basically, my premiums tripled because insurance companies were no longer able to charge higher premiums to older people or higher risk people. So, normally healthy people were on the hook for the difference.

[wxgkbpn]

In 2012, we lost affordable insurance altogether and had to go with a sharing program to avoid the penalty. Have never used it, it's cheaper to pay out of pocket.
Now, we are getting better insurance offers now that insurers are not required to issue a policy.
They are still unaffordable, though. The ministries ha e better coverage and rates.

[garimasingh]

Very clear parallel between ACA and AHCA drawn. Loved the information and the style of communication. Three Cheers!

[karatgirl]

What about those who wouldn't use the insurance? Some use alternate choices for healthcare and don't want insurance...