New England Journal of Journal Takes Stock Before Court Decision New England Journal of Medicine article “The Affordable Care Act at 5 Years,” by David Blumenthal, MD, MPP, Melinda Adams, and Rachel Nuzum, MPH.

The lead author, Dr.David Blumenthal, is a quintessential ObamaCare supporter. He received his undergraduate, Medical, and Health Policy Degrees from Harvard. He served as professor of medicine at Harvard Medical School. He was Obama’s first National Coordinator of Health Information Technology. He was chief information and innovation officer at Partner’s Health System. He played an important role in developing RomneyCare, the prototype for ObamaCare. And he is now president of the Commonwealth Fund in New York City, a national philanthropy whose mission is to promote an support a high performing health system offering greater access, improved quality, and greater efficiency for society’s most vulnerable low income , uninsured, minorities, children, minorities, and young adults.

Given these characteristics, What do Blumenthal et al and the New England Journal have to say about the Affordable Care Act? Blumenthal is on the board of editors of the The Journal. All of these constituencies support the ACA and yearn for its success. While they are cautiously optimistic, they are also guarded as evidenced by their careful wording about its prospects.

They note the ACA 11.7 million have selected a health plan under health exchanges, that 10.8 8 million have enrolled in Medicaid since ACA enactment, that 3 million young Americans have gained access under their parents’ plans, that 8 to 12 million have benefited from regulations that prevent discrimination for people with pre-existing condition, and that 30 million now have insurance under new sources of coverage.

But they are also aware of ACA problems, the botched launch, cancelled politics, narrowed networks, and substantial increases in premiums, copayments, and deductibles.

And they strike these cautionary notes.

“The heated political debates over the ACA and lack of definitive evaluations for so many of its numerous programs complicate efforts to assess its track record at the 5-year point.”

“Profound philosophical objections to federal initiatives in health and other policy areas have deep roots in American political discourse and will probably persist, guaranteed that the ACA will remain controversial

They end with the usual optimistic view that people will like the ACA once they get used to its benefits.

“Time will tell whether the contributions of the ACA will moderate these philosophical objections and create the kind of broad public support for the ACA that Medicare and Medicaid – also controversial when they pass – now enjoy.”

They are hoping for the best but fear for the worse while whistling in the dark.