Funders on both the left and the right have spent a fortune in the battle over Obamacare, and that battle isn't over by any means, with a funder-backed Supreme Court challenge still unfolding, and a grinding fight over Medicaid expansion ongoing in many states.
But with the Affordable Care Act largely in place and operational, more funders have been investing in evaluating the effects of the law. As we recently reported, for example, the Russell Sage Foundation has launched a new effort to research the law's impact on America's social, civic, and economic life.
Meanwhile, some of the research shops that earlier projected the law's likely impact are getting funding to assess its actual impact.
Prime among these is the Urban Institute. Amid all the partisan hype surrounding the pros and cons of Obamacare, the institute has maintained its reputation for clear-eyed objectivity while assessing the act’s impact.
A key theme of the institute's analyses of the Affordable Care Act has been that the law would not be as explosively disruptive as some critics have imagined.
Over recent years, the Urban Institute's research has suggested that the ACA would not increase health care costs and reduce employer-sponsored coverage. It would increase costs for medium-sized businesses since more people would be covered, but it would leave small businesses better off financially. Overall, it said, the law would “have a negligible impact on total employer-sponsored coverage and costs.” As for being a "jobs killer," UI projected that the law would reduce unemployment in some ways, but increase employment in others, and the total effects on job growth wouldn't be dramatic.
The Robert Wood Johnson Foundation has been a key backer of the Urban Institute's health care work over recent years. It's made grants to UI to explore the ACA from various angles, particularly how the law is playing out in the states, which is the focus of major ongoing work. In 2010, the year the ACA was enacted, RWJF paid for the Urban Institute’s report “America Under the Affordable Care Act,” which simulated the ACA as if were fully implemented that year, contrasted with actual 2010 data.
The foundation's latest grant to UI, for $500,000, will support research on the effectiveness and impact of the ACA. UI will examine the strengths and weaknesses of Medicaid expansion, health insurance marketplaces and subsidies.
This grant comes as a legal Sword of Damocles hangs over the Affordable Care Act, as the Supreme Court deliberates the constitutionality of the law's health insurance subsidies. The Urban Institute has already been gaming out what could happen if the court decides in favor of the plaintiffs in the King v. Burwell case, who contend that subsidies only apply to the states with their own marketplaces and not to residents in states that rely on the federal exchanges. If the Supreme Court buys that argument, the institute estimates that the number of uninsured would rise by 8.2 million people who depend on the $28.8 billion in tax credits and that “average nongroup premiums in 34 states would increase by 35 percent, affecting those purchasing inside and outside those Marketplaces.”
All of which is to say that it's a volatile and tricky time for policy wonks working on the ACA. On the one hand, major work needs to be done to assess the law's impact in its present form. On the other hand, researchers have been scrambling to project what might happen if SCOTUS drives a stake through the heart of Obamacare.
No foundation has a bigger investment in the future of the ACA than the Robert Wood Johnson Foundation, which has spent tens of millions to help pass and implement the law. As far as we can see, it plans to stay on this case in a big way.