Thread by @DrewAltman

Before 2020 starts in earnest tomorrow, here are 11 highlights and lowlights in health policy over the 2010s:

#decadeofhealthpolicy

Health became the poster child of the partisan divide. And the partisan division replaced health care’s legendary interest groups as the most powerful force shaping health policy. (1/11)

We saw a gradual but fundamental change in what insurance is in the U.S., from more comprehensive to skimpier coverage, with much larger deductibles.

People with major illnesses and lower wage workers are hit the hardest. (2/11) axios.com/employer-based…

Although health spending moderated, we remain unable to address our major cost problem: The high prices we pay for everything in health care. (3/11)

The ACA became law – significantly expanding coverage, reducing the ranks of the uninsured, and reforming insurance rules to protect consumers. It appears to have staying power. (4/11)

Consumer pocketbook issues broke through, with drug costs and surprise bills leading the way, especially in Congress. But the prospects for legislative action are murky. (5/11)

Progressives captured the health agenda on the left.
And, the public option – previously considered a bridge too far – became the more incremental alternative for candidates to Medicare-for-all. (6/11)

Medicaid became a protected species – more like Medicare and Social Security.

The close-call failure of repeal and replace turned as much on opposition to block granting and cutting Medicaid as it did on the ACA. (7/11)

While Washington may be gridlocked, lots of action in the states, with red states and blue moving in opposite directions.

Texas and Florida remained Medicaid expansion holdouts, while Washington and Colorado are implementing their own public options. (8/11)

We saw a new focus on the social determinants of health in health care. But it remains to be seen whether the health system is best point of intervention when it comes to root problems like poverty, affordable housing and violence. (9/11)

The opioid epidemic took center stage and the HIV epidemic remained stubbornly persistent, especially in the South. We saw a new and needed emphasis on public health. (10/11)

Health became the top issue for Democratic and Independent voters, but the main factor for all voters is getting rid of, or keeping, President Trump. (11/11)

All told, it was a decade of real progress on coverage but less so on costs, especially for consumers who have been hit hard by out-of-pocket costs.

As things sit today, health care is both a symptom of partisan divide and policy paralysis, and a continuing cause of it.

With the federal government gridlocked, the action is in the states for 2020.

With legislation in Congress likely to be blocked by partisan division and interest group opposition, much of the real action in health care this year will be in the states. axios.com/health-care-20…