1. Molyneux, Jacob senior editor


The reasons for the Affordable Care Act may be forgotten but are more serious than ever.


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In mid-September the U.S. Census Bureau reported that the number of people without health insurance increased in 2009 to an all-time high of 50.7 million. (To read the report, go to Much of this increase can be attributed to the loss of employer-sponsored health coverage as the recession worsened during 2009-but even before the recession, the number of uninsured had reached a crisis point.

Figure. Number Unins... - Click to enlarge in new windowFigure. Number Uninsured and Uninsured Rate: 1987 to 2009

The Patient Protection and Affordable Care Act, signed into law in March, is projected to eventually insure about 34 million more Americans. Provisions that took effect in September are already helping some groups-including those 26 years old or younger who live at home with insured parents and those who could be denied coverage because of a preexisting condition-although many provisions don't take effect until 2014. Reform opponents are unlikely to repeal the legislation, but in the weeks leading up to the midterm elections, they were laying plans to hinder the funding necessary to implement numerous provisions (read a Washington Post report on Republicans' plans at


Meanwhile-continuing a pattern that began well before the reform law passed-costs are rising even for the insured.


Premiums of many employer-provided plans will increase 10% to 30% for 2011, according to California Healthline (, with some deductibles doubling. An AARP report released in August ( found that prices of brand-name prescription drugs notched up 9% in 2009, with many of the most popular drugs jumping 40% to 90% in the past five years.


And a recent Ohio survey published in Business Week ( found that 13% of parents with health insurance-including many middle-income parents-said they'd foregone recommended drugs and treatments for their children.


To make it easier for those without employer coverage to shop for health insurance in an intricate market, the government Web site launched Insurance Finder ( this summer, which compares plans' costs and restrictions. It's also intended to increase competition among insurers.


Consumer Reports also offers a Web site (much of its content requires a subscription) that rates insurance plans as well as surgical groups, treatments, medications, supplements, and other aspects of health care.


The explosive but unavoidable question of how to bring down costs will have to be faced sooner or later by all stakeholders in our health care system. Look especially for intensifying attention in 2011 on comparative effectiveness research on the relative benefits of various treatments.-Jacob Molyneux, senior editor