December 5, 2012 -- A panel of experts – including John Podesta, President Clinton’s former chief of staff – expressed their hopes and predictions for the future of the Affordable Care Act (ACA) at a Dec. 3 event hosted by Georgetown Public Policy Institute (GPPI) students.

“I think that the Affordable Care Act will be implemented,” Podesta said. “Once it’s rooted, it will be very hard to uproot. I think people will begin to understand what the important components are that are valuable.”

Accompanying Podesta on the panel were Linda Blumberg, senior fellow at the Urban Institute’s Health Policy Center, and Colin Roskey, partner in the Health Care Legislative and Public Policy Group of Alston & Bird, LLP. GPPI professor Judith Feder moderated the panel.

Accepting a Framework

Despite believing implementation will occur as planned in 2014, Podesta said some questions remain concerning implementation, including whether states will pick up Medicaid expansion.

“The acceptance of the overall framework is predicated on … two things,” said Podesta, the founder and now chair and counselor of the Center for American Progress. “Medicaid expansion and moving the overall system to produce better results at lower costs.”

Roskey said he’s optimistic that both Republicans and Democrats are now ready to move forward after being originally unwilling to examine minute details of the ACA.

Bipartisan Support

“I think each side had its own reasons for wanting to stay away from some of that surgery that was needed…,” Roskey said, “but we have sensed, in my practice, a real warming effect, both from Democrats and Republicans, who now want to look at provisions that will perfect [the ACA’s] implementation.”

Roskey adds that as a bipartisan health law and policy firm, “we are optimistic … that there are real opportunities, especially in the delivery system space, to perfect and improve on population health through the use of novel delivery system reforms.”

Prominent State Role

Blumberg is researching the implementation of the ACA and its impact on cost and coverage in 10 different states.

“One of the things we learned when we were going into these 10 different states,” she said, “was that there was a lot of groundswell among thoughtful folks on both sides of the political aisle that the states should have a very prominent role in developing a path for their involvement in the ACA and its implementation.”

Blumberg said the Medicaid expansion and the financial assistance provided through the option for states to develop a health insurance exchange will become the sources of the ACA’s expansion coverage.

“Those two pieces are enormous pieces. If they are not implemented effectively…then you don’t get the increase in coverage that you’re looking for,” she explained.

“What we’re talking about is a situation where states have always been a predominant regulator of private health insurance in this country,” Blumberg added.

She said the ACA would set “minimum standards for a number of these rules and how they operate at the state level,” but still look to the states to enforce and oversee the implementation of those regulations.

Educating the Public

“I think that there’s a big question going forward for 2014,” Feder said of publicizing the ACA. “It’s whether Americans are really ready to get out there and sign up. We know that they have mixed views on the Act … what’s going to happen when we open the doors in 2014?”


Roskey said he believes “with a fair amount of education in 2013 by the IRS and by the Department of Health and Human Services and others, [the ACA] will be in effect in January of 2014.”


Brumberg emphasized the need for increased information and communication to the public, particularly young people.

Calling for Outreach

“I think it can’t be understated how much misinformation has been put out among the public,” she said. “And the way that people get information today lends itself to misinformation being spread very quickly.”

She called for outreach from government, consumer advocates, and providers.

“It’s very important for that first year and the first couple of years to make sure you’re attracting as many of the healthy population into these exchanges as possible so that we don’t have on day one, average premiums very high,” she said. “We really need young people, especially, to be made aware of what they’re eligible for, and to be making these systems easy to access [for them].”