To the Editor:
I generally agree with the idea that the government should engage more actively with its constituents regarding federal policies to challenge the submerged state, but I believe the effects of the Affordable Care Act did not go unnoticed.
Many initiatives in the ACA took years to implement, and they took effect gradually over the course of several years. A few of the milestones, such as long-term care insurance (2011), 3.8 percent surcharge on individuals who make over $200,000 (2013) and prohibition of insurance companies from denying individuals with preexisting conditions (2014) were all implemented after the 2010 midterm elections. Indeed, one of the most important pieces of the ACA — the Medicaid expansion — became effective in January 2014 and the Congressional Budget Office is continually updating the increase in health insurance coverage rate today.
While there are provisions in the ACA that may go unnoticed, milestones like Medicaid expansion probably did not escape the public eye. Correlation is not causation, but the approval rating for the ACA steadily increased beginning in 2014 and is still trending upward. The voters in 2010 simply did not have the benefit of observing the ACA’s achievements over the course of all these years.
Prof. Suzanne Mettler, government, points out an important idea in principal-agent relationship and the challenges we face in making the benefits of social welfare more salient to the public. There are policies with tremendous social benefits that are submerged. We should heighten our awareness of those policies. However, I do not believe it is apt to characterize the ACA as an example of submergence given its spotlight and the uncertain nature of health policy.
B.S. Policy Analysis and Management ’14, College of Human Ecology
M.S. Health Policy and Economics ’18, Weill Cornell Medical College