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Insuring a Future: The ACA & American Health Care Reform

5:30 PM
Pierson Auditorium, Atterbury Student Success Center, UMKC

Insuring a Future: The ACA & American Health Care Reform

5:30 PM
Pierson Auditorium, Atterbury Student Success Center, UMKC


What will happen to Obamacare? It’s been a contentious few months for—among other political initiatives—health care, with many stops and starts, old and new challenges, and revived uncertainties that have left Americans confused about the state of the Affordable Care Act.

At this Truman Series event presented by American Public Square, The Harry S. Truman Library & Museum, the Truman Library Institute, and the Harry S. Truman Center at UMKC, our panel of experts discussed where we are with the ACA and where we may be headed.


Joseph R. Antos is the Wilson H. Taylor Scholar in Health Care and Retirement Policy at the American Enterprise Institute and adjunct associate professor of emergency medicine at the George Washington University. He is the Vice-Chair of the Maryland Health Services Cost Review Commission, where he is serving a third term as a commissioner. Previously, Antos was Assistant Director for Health and Human Resources at the Congressional Budget Office, and he held senior management positions in the U.S. Department of Health and Human Services, the Office of Management and Budget, and the President’s Council of Economic Advisers. His work focuses on the economics of health policy, including the Affordable Care Act, Medicare, the uninsured, and the overall reform of the health care system. Antos earned his Ph.D. in economics from the University of Rochester

Rachel Nuzum, M.P.H., is vice president for the Federal and State Health Policy initiative at The Commonwealth Fund, working closely with policymakers at the state and federal level. Ms. Nuzum is responsible for developing and implementing the Fund’s national policy strategy for improving health system performance, ensuring that the work of the Fund and its grantees informs the policy process in both the legislative and executive branches of state and federal government. Ms. Nuzum’s work also includes fostering public–private collaboration on health system performance improvement with state and federal stakeholders and organizations.

Ms. Nuzum has over 15 years of experience working in health policy at the federal, state, and local levels of government, as well as in the private sector. Before joining the Fund in January 2007, Ms. Nuzum was a legislative advisor for Senator Maria Cantwell (Wash.) on health, retirement and tax issues. Prior to joining Senator Cantwell’s office, she served as a David Winston Health Policy Fellow in Senator Jeff Bingaman’s (N.M.) office. In this role, Ms. Nuzum staffed the Senator on the Health, Education, Labor and Pension Committee and the Senate Finance Committee. Before arriving in Washington, D.C., she served former Governor Roy Romer of Colorado in the office of Boards and Commissions and worked as a health planner in west central Florida. She holds a B.A. in political science from the University of Colorado and an M.P.H. in Health Policy and Management from the University of South Florida. She is on the faculty of Georgetown University’s Graduate School of Nursing and Health Professions and is on the board of the Winston Health Policy Fellowship.

Julie Rovner, the Robin Toner Distinguished Fellow, is Chief Washington Correspondent. She joined KHN after 16 years as health policy correspondent for NPR, where she helped lead the network’s coverage of the passage and implementation of the Affordable Care Act. A noted expert on health policy issues, Julie is the author of the critically praised reference book Health Care Politics and Policy A-Z, now in its third edition. In 2005, she was awarded the National Press Foundation’s Everett McKinley Dirksen Award for distinguished reporting of Congress. Prior to NPR, Julie covered health policy for National Journal’s Congress Daily and for Congressional Quarterly, among other organizations.

David Slusky, Ph.D., is an Assistant Professor of Economics and an Oswald Scholar at the University of Kansas, where he also co-directs the Health Policy Research Group and is a faculty affiliate of the Institute for Policy & Social Research. His research focuses on how changes in public policy and environmental exposure affect health outcomes, primarily for women and children. Recent publications show that women’s health clinic closures due to funding cuts reduce preventive care and that increases in maternal sunlight exposure reduce childhood asthma. His results have received substantial press coverage, including in the EconomistFiveThirtyEight, the Huffington Post, the New York Post, NPR, SlateVox, and the Washington Post. Dr. Slusky’s research has also been funded in part by the Health Care Foundation of Greater Kansas City. He also teaches courses on micreconomic theory, labor economics, and health policy, and advises graduate students working on dissertations in industrial organization and the economics of education. Previously, Dr. Slusky was a management consultant in Oliver Wyman’s financial services practice in New York City. He holds a doctorate in economics from Princeton University, and an undergraduate degree in physics and international studies from Yale University.


Brian Ellison is host of the KCUR political podcast Statehouse Blend Missouri and regular substitute host of Central Standard and Up to Date. He also contributes to KCUR news coverage, including reporting on Missouri politics, anchoring election night broadcasts and hosting various live events in the community. An ordained Presbyterian minister, Brian is also executive director of the Covenant Network of Presbyterians.

Roving Reporter

Dan Margolies is an editor/reporter at KCUR, helping to oversee the station’s health, education, legal affairs, and general news coverage. He joined KCUR in April 2014.


Download PDF or see below

The Affordable Care Act, also known as Obamacare, became law March 23, 2010. It was mostly implemented by 2014.

The goal of the ACA is make affordable health insurance available to more people, expand the Medicaid program, and lower the costs of health care. (Source)



    Parents with insurance from their employer can add their adult children to their plans (up to age 26).

    Insurance companies cannot drop a person due to an illness, nor can they deny coverage due to a person with a pre-existing condition Insurance premiums are community rated. Premiums can vary only according to the age of the purchaser.

    Wellness and pregnancy exams are now free to patients under ACA.

    States have the option to expand Medicaid eligibility up to 138% of the federal poverty level.

    Anyone can compare health insurance plans through the exchange, which is an online marketplace where individuals, families, and small businesses are able to compare plans, determine if they are eligible subsidies or tax credits, and purchase health insurance coverage. (Source)



    Ambulatory patient services

    Emergency services


    Maternity and newborn care

    Mental health & substance use disorder service

    Prescription drugs

    Rehabilitation and habilitative services and devices

    Laboratory services

    Prevention, wellness, and chronic disease management services

    Pediatric services including vision and dental care




    Included in the ACA was an individual mandate that financially penalized anyone who did not sign up for health insurance.

    Repealing the mandate saves $300 billion over ten years but increases the number of people without insurance by 13 million in 2025 (Source).

    The recent tax bill eliminated the financial penalty, effectively repealing the individual mandate.



    Between 2014 and 2015, the uninsured rate decreased in 47 states and the District of Columbia. (North Dakota, South Dakota, and Wyoming did not experience a statistically significant change in their uninsured.) (Source)

    In 2015, the percentage of people without health insurance dropped for all ages under age 65. (Source)

    In 2016, 28.6 million Americans were without health insurance, down from more than 48 million in 2010.* (Source)

    *11.6 million purchased their plans through the federal Health Insurance Marketplace or state-based exchanges established by the ACA.

    In 2016, almost 17 percent of adults aged 25-34 lacked insurance, while less than 9 percent of those aged 45 to 64 were uninsured. (Source)

    States that chose to expand Medicaid coverage to people with low incomes had the ranks of their uninsured cut in half, from 18.4 in 2013 to 9.2 percent in 2016. In states that did not expand Medicaid, the rate moved down slightly, from 22.7 in 2013to 17.9 percent in 2016. (Source)

    18 states that haven’t expanded Medicaid including Kansas and Missouri.

    In Kansas about 86,000 individuals enrolled in health plans offered through the health insurance exchange in 2017. Medicaid Enrollment was about 387,000 in May 2017. (Source)

    Between 2013 and 2016, uninsured individuals in Kansas fell from 11.5 percent to 9.8 percent. (Source)

    In Missouri about 213,000 individuals enrolled in health plans offered through the health insurance exchange in 2017. Medicaid enrollment was about 975,000 in May 2017. (Source)

    Between 2013 and 2016, uninsured individuals in Missouri fell from 13 percent to 9.8 percent. (Source)

    83 rural hospitals closed between 2010-2017, mostly in non-expansion states. (Source)

    Texas, Louisiana, Mississippi, and Florida had the highest percentage of uninsured residents. New York, Ohio, Michigan, Minnesota, and California had the lowest percentages. (Source)

    Data on uninsured adults aged 18–64 by race and ethnicity for the first 6 months of 2016 shows 24.8% of Hispanic, 14.8% of black, 8.7% of white, and 7.2% of Asian adults lacked health insurance. The uninsured rate of Hispanic adults had the largest decrease from 40.6% in 2013. (Source)

    8.8 million people have signed up for 2018 coverage on the federal exchange. Nearly 2.4 million consumers were new to the exchanges, while more than 6.4 million continued their coverage during the open enrollment period. (Source)



    “2016 Health Insurance Enrollment: Private Coverage Declined, Medicaid Growth Slowed,” E. Haislmaier and D. Gonshorowski, (The Heritage Foundation, July 26, 2017),

    “Are U.S. Health Insurers Finally Getting To Stable Ground In The ACA Individual Market?” (S&P Global, Jan. 5, 2017),

    “How Premiums Are Changing in 2018,” A. Semanskee, G. Claxton, and L. Levitt, (Kaiser Family Foundation, Nov. 14, 2017),

    “Insurer Participation in ACA Marketplaces: Federal Uncertainty Triggers Diverging Business Strategies,” E. Curran, J. Giovanelli, and K. Lucia, To The Point, (The Commonwealth Fund, Jan. 5, 2017),

    “Is the Affordable Care Act Helping Consumers Get Health Care?” M. Z. Gunja, S. R. Collins, and H. K. Bhupal, (The Commonwealth Fund, Dec. 6, 2017),

    “Steps Toward a More Sustainable Individual Health Insurance Market,” Issue Brief, (American Academy of Actuaries, April 2017),

    “Following the ACA Repeal-and-Replace Effort, Where Does the U.S. Stand on Insurance Coverage?” S. R. Collins, M. Z. Gunja, and M.M. Doty, (The Commonwealth Fund, Sept. 7, 2017),

    “Health Care Executive Order Would Destabilize Insurance Markets, Weaken Coverage,” S. Lueck, (Center on Budget and Policy Priorities, Nov. 29, 2017),

    “Health Care Order Expands Insurance,” M. D. Tanner, (CATO Institute, Oct. 15, 2017),

    “National health expenditure report shows we have not solved the cost problem,” J. Antos and J. C. Capretta, (American Enterprise Institute, Dec. 6, 2017,)

    “What’s at Stake: States’ Progress on Health Coverage and Access to Care, 2013-2016,” S. L. Hayes, S. R. Collins, D. Radley, et al., (The Commonwealth Fund, Dec. 14, 2017),

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