An interview with Mark Pauly, one of America’s leading experts on health-insurance markets
For years, Republican politicians assailed the Affordable Care Act for causing health-insurance premiums to rise, out-of-pocket costs to soar, and insurers to drop out of the marketplace altogether. Yet the congressional GOP has failed to enact legislation to supersede it, despite enjoying majorities in both houses and a Republican president. Nonetheless, incremental reforms have been made. President Trump issued an executive order to make available cheaper insurance plans outside the framework of the ACA’s regulations, and Congress has repealed the individual-mandate penalty, to which individuals purchasing such non-ACA-compliant plans would otherwise have been subject.
Congressional Democrats suggested these reforms would “undermine consumer protections, disrupt the individual health insurance Marketplaces, and expose consumers to great financial risk,” while the Washington Post attacked the new options as “cheap, substandard plans” that portended a “disastrous escalation of costs.”
Mark V. Pauly is a professor of health-care management at the Wharton School of the University of Pennsylvania and one of America’s leading experts on health-insurance markets. Over the past five decades, the publications he has written and the students he has trained have done much to define the field. In a 2010 monograph, “Health Reform without Side Effects,” Pauly discussed the Affordable Care Act’s insurance-market reforms — anticipating many of the difficulties it has faced, and suggesting more appropriate means of fixing problems with insurance markets.
I called Pauly to learn what he thought of the developments of recent years, and to get his assessment of the Trump administration’s recent initiatives. The conversation has been lightly edited for clarity.