President’s Message CeCIl D. b Ykerk
Civic Service
our CountrY Is now about HalF a Year beYonD the historic supreme Court ruling regard-
ing the Patient Protection and affordable Care act, more commonly referred to as the affordable Care act
(aCa). this legislation is 974 pages long, and, for the most part, all of it was upheld by the u.s. supreme Court
on June 28, 2012. some Medicaid provisions were pared back by the supreme Court—and we, as a nation,
still are trying to understand the full ramifications of that—but the rest of aCa remains the law of the land.
In my first column, I described the focus of the Academy’s
Summer Summit on health care costs and how we want to pur-
sue getting actuarial input into the national discussion. As I look
further ahead in 2013, I am certain that much will change in the
area of health care financing. I also know that actuaries can help
in this transition. Over the nearly quarter century that I have
functioned as a health actuary, many things have been tried in
the effort to provide health care services to all Americans while
preserving the private marketplace for delivery of those services
and the private financing that funds them. We have had small
group reform with reinsurance mechanisms. We have had state
experiments focused on the individual marketplace—some have
stuck, others have not. And we have seen various changes to
federal and state health programs. While almost all of these in
concept have increased or improved access to care, they have
done little to affect costs—at least in a positive direction (by that
I mean toward a negative or slower growth rate). In fact, some
actually have caused costs and (as a result) premiums to rise. Un-
fortunately, the general public does not seem to fully appreciate
the relationship between health care costs and premium levels.
gerr Y CHaPleskI / DreaMstIMe
8 CONTINGENCIES JAN | FEB. 13
