After Five Years: The Impact of the Affordable Care Act

In an entirely symbolic move, Senate Republicans approved legislation December 3 that, if passed, would repeal the Affordable Care Act (ACA).

Similar measures have been approved in the House of Representatives some 50 times, but this is the first time one has been approved in the Senate, thanks to a special loophole in the budgetary procedure that was used to reduce the number of votes required to approve legislation.

Senate Republicans propose eliminating the provisions requiring individuals and employers to purchase or provide health insurance (the Individual and Employer Mandates). Also eliminated are government subsidies for Marketplace-based insurance, Medicaid expansion, and the Cadillac tax.

Republicans believe that rising healthcare costs – healthcare spending grew at 5.3 percent in 2014, the fastest rate in Obama’s presidency – and the move by some insurers away from the Marketplace are signs that the ACA is failing. Is that a fair assessment? Let’s take a look at some of the numbers.

2015

  • Studies suggest that an additional 22.8 million people enrolled in coverage thanks to the ACA, while 5.9 million lost plans, for a net gain of 16.9 million newly insured Americans in 2015 alone.
    • 6 million people are newly enrolled in employer-sponsored health plans.
    • 5 million people are newly enrolled in Medicaid. Between 2010 and now, it’s estimated that the number of new Medicaid enrollees is closer to 10.8 million.
    • 1 million people are newly enrolled on the Marketplace. The total number of Marketplace enrollees is estimated to be closer to 11.7 million.
    • 5 million people are newly enrolled in other insurance sources.
    • 2 million people are newly enrolled in non-Marketplace individual plans.
  • The number of uninsured young and/or low-income people has dropped to the lowest levels since 2001. Since 2010, 5.7 million young people have taken advantage of ACA provisions to remain on their parents’ plans until age 26.
  • 25% more insurers have joined the Marketplace since 2014, increasing consumer choice.

2014

  • While 2014 saw healthcare spending grow at the steepest rate in Obama’s presidency, the administration argues that the pre-ACA growth rate was frequently far higher. They also note that the growth rate is heavily impacted by federal spending, which increased with both Medicaid and Medicare expansion (the first wave of baby boomers are just beginning to qualify for Medicare).
  • Hospitals’ unreimbursed care costs are estimated to be $7.4 billion (21%) lower than they’d have been without the ACA.
  • Preliminary data suggests that between 2010-2013, as a result of the ACA, 1.3 million fewer events requiring patient hospitalization occurred. As a result, the number of hospital acquired conditions dropped, saving an estimated 50,000 lives and $12 billion.

2010-2013

  • Preliminary data suggests that between 2010-2013, as a result of the ACA, 1.3 million fewer events requiring patient hospitalization occurred. As a result, the number of hospital acquired conditions dropped, saving an estimated 50,000 lives and $12 billion.

The ACA is far from perfect, but these numbers suggest that it has had a positive effect on healthcare in the US. It will be interesting to see whether or not these trends continue.