The Affordable Care Act is becoming less affordable.

Premiums are rising and so are deductibles and out-of-pocket expenses. Costs are increasing for both employers and consumers. And last year national health expenditures jumped 5.3 percent. (In 2013 the jump was 2.9 percent.)

The nation’s health care bill is not growing as fast as it did prior to the 2010 health reform law, but the jump in 2014 nonetheless is troubling as health care spending reaches 17.5 percent of our GPD.

Prior to our winter conference, in a discussion led by Quality Institute Board Member Heather Howard, a former New Jersey Health Commissioner, our board members and leadership council tackled ways to move the ACA forward. The challenges are great.

Yet we believe the ACA, especially its expansion of health insurance coverage to some 17 million more Americans, must continue — and will continue — with solutions crafted with input from leaders in all sectors of health care. At the Quality Institute, we bring together providers, insurers, consumers, hospitals and leaders in non-profits and business. We are in a unique position to lead the search for solutions.

I wish I could tell you we solved the great trials ahead for health care reform in America and that we came to consensus on all issues. Alas, we did not. But what emerged from our discussion were important and valuable ways to improve the ACA and health care system in NJ.

• Streamline regulation and paperwork for employers, consumers and providers. The ACA paperwork currently could drown a rat. Simplifying the system will reduce costs and make the ACA more effective.

• Improve the technology that consumers need to select a plan. Technology that easily allows consumers to compare plans — and find the ones that best cover the prescriptions they need, as well as the providers they prefer — will help consumers find the plan that fits them best.

• Provide physicians and other providers with an evidence-based system to help guide decision-making and reduce inappropriate care. Care that does not help and sometimes harms patients adds as much as 30 to 40 percent to our health care costs.

• Support physician decision making to reduce defensive medicine from physicians fearful of medical malpractice suits. We know that some physicians will order unnecessary medical tests to protect themselves from the possibility, even remote, of lawsuits. Evidence-based systems can guide and protect physicians and building the use of those systems into our legal system by looking at current burdens of proof in malpractice suits is a fair and timely issue to consider.

• Engage communities around issues such as end-of-life care. We know we spend an enormous amount of health care dollars on end-of-life-care that does not improve quality of life and often does not extend life. This is not just a question for doctors. All of us must have conversations with our loved ones — and we must initiative conversations with our providers — to insure that our end-of-life wishes are followed.

This is a conversation that must continue and I invite all of you to examine the ACA from your special perspective and share your thoughts and ideas with me. The creation of health reform was long fought and political battles continue. We need innovative ideas and insight to make sure we do not turn back the clock.