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Patt Morrison Asks

Drew Altman, Obamacare's ref

As the head of the Kaiser Family Foundation, he deals not with lab numbers for a few patients but with healthcare data for millions. With Obamacare stumbling out of the gate, the foundation has been marshaling its data on behalf of consumers and providers to clear the fog of policy.

November 19, 2013|Patt Morrison

He might have become a doctor like his father, but a grad school (Harvard) summer job researching health policy changed all that. Now as the head of the Kaiser Family Foundation, Drew Altman deals not with lab numbers for a few patients but with healthcare data for millions. For years he headed up state and federal programs on welfare reform, homelessness and Medicaid. Since 1991, he's shaped the Menlo Park-based foundation as "a trusted source of information in a healthcare world dominated by vested interests." With Obamacare stumbling out of the gate, the foundation has been marshaling its data on behalf of consumers and providers to clear the fog of policy.

The administration says don't confuse the mechanics of the Affordable Care Act with the program, but at the outset, don't the mechanics become the program?

There's no question that people are mightily confused, [as] we see in our monthly tracking polls. People have been witnessing a three-year slugfest of a debate, and only now is the law becoming real — with a horrible rollout of a website. Add to that the fact that the law is complex and affects different people in different ways. Early next year we'll get a better fix on how this is doing. Ultimately this isn't about the website, it's about people who get coverage [answering] one question: Is this a good deal for me or not?

In the first year, it'll be 15 or 16 million people who get coverage [according to government estimates] — not a lot in a country of 300 million, so we'll be making a judgment based on a relatively small number of people. A lot is going to turn on what the news media do; this law is ripe for death by anecdote. The Kaiser Family Foundation has our own news service, but there's a serious challenge for the news media to get out and see how the law is working and not just find one juicy story that makes headlines.

What is the foundation's mission?

Being an independent source of information. We may not be appreciated by everybody because facts are sometimes annoying to all sides, but we're credible with everybody. The facts aren't a magic wand in a polarized, super-heated political system, but they certainly help.

Who's doing the ACA right?

California is absolutely a leader in embracing the ACA and implementing it. As California goes, so goes the nation. We're tracking 2,000 uninsured [California] families to see how they're affected by the ACA. If the challenges can be met in California, they can be met anywhere.

You're friends with former Health, Education and Welfare Secretary Joseph Califano, who created the agency that runs Medicare and Medicaid. Any parallels there?

Medicare was attacked by the right, treated as a socialist plot. I think he would say the heat is really turned up because of the toxic polarization in our political system, but this isn't the first time we've had controversy around the rollout of a big program.

There was partisan rancor in 1989, when President George H.W. Bush nominated you to run Medicare and GOP conservatives objected because you were an independent, not a Republican.

It is true. I worked for Democrat Jimmy Carter, for Republican Tom Kean [former New Jersey governor]. The law has become a symbol of ideological and partisan differences. In the past, we've been able to make changes; that's been the history of Medicare and Medicaid, and it's especially relevant to ACA, which in effect is a big nonscientific experiment where things are going to look different in each state. We have a huge opportunity to learn what works and what doesn't. But what is the capacity of our polarized political system to do that nowadays? Can this Congress learn and improve the ACA? The answer to that is probably not.

Could a workable ACA make all that much difference?

People are terribly worried about their healthcare bills, especially [the] uninsured. They desperately want coverage, and that's true of young adults, who everybody thinks don't want coverage. At the level of families around the kitchen table, it's not about Obamacare as a political symbol; it's about, does this make sense for me?

People don't understand the connection of health insurance to their lives and budgets. It's not only that [they] will have coverage, but because they will have a way to pay for healthcare, it will be easier to pay for food, for clothes, for rent, for gas to get to a job. That is the most profound effect.

The ACA also eliminates the worst abuses in the health insurance system: people with preexisting conditions now don't have to worry that they'll be excluded from coverage or their rates jacked up. That's a big deal. Roughly half the American people say they or a family member has a preexisting condition.

Can anything hold down medical costs?

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