How will we know if the Affordable Care Act is working: A view from Chicago

For those of us who have worked for decades for healthcare reform, the Affordable Care Act was presented as a significant step forward.  Millions now have health insurance who did not.  People with pre-existing conditions can get new insurance.  The ACA has banished life-time caps and requires free preventive screening.  But, although the rate of increase of healthcare costs has flattened, costs are still rising faster than inflation.  Many people who have insurance may not be able to afford deductibles and co-pays that come with their new policies.  Cut backs in Medicare coverage will change treatment options.  Many states expanded Medicaid coverage, but the bill for this expansion, even considering federal assistance, might burden state budgets in out years.  And the sad moral truth is that millions of people who didn’t have healthcare coverage in 2009 will not have coverage in 2020.  It is too early to tell how all of this will turn out, but now is the time to start asking the questions that will allow us, ultimately, to know the extent to which the ACA is working.  By focusing on the realities of healthcare in Chicago and its surrounding suburbs, this project will identify possible factors that ought to be part of a model to examine the success or shortcomings of the ACA, thereby beginning  a dialogue that could facilitate evaluations of the law, when the time comes.