It’s hard to believe that the Affordable Care Act (ACA), colloquially called Obamacare, was signed into law 6 years ago. Many have described it as the most important expansion in health coverage in the last 50 years, while others have deemed it the beginning of the end of American healthcare. Either way, it’s too early to gauge the success (or failure) of Obamacare, as it has only gone into effect since 2014.
So how do we measure the continuing performance of Obamacare?
We first look at what Obamacare has promised to do: to increase the affordability of health insurance, lower the rate of uninsured, and reduce U.S healthcare spending. Then, by looking at the data, we see its progress and what the future holds for healthcare in America.
Health Insurance Is More Affordable Than Before
Several studies have shown that the subsidies offered by the ACA make health insurance more affordable for a majority of Americans. This is because the ACA grants more subsidies to those close to the federal poverty line, and the majority of Americans fall closer to the line than farther.
To put it into numbers, that 133 % above the poverty line pay a max annual premium of $992 for healthcare, while those at 400% pay a max of $8,379. Does this mean that those who are higher above the poverty line will be paying more? Yes, but as a whole, more people are paying less for insurance and fewer people are paying more. Additionally, the Kaiser Family Foundation has found that most people who have private insurance are eligible for subsidies with the ACA—further increasing the notion that the ACA has increased the affordability of health insurance.
The Rate of Uninsured Has Decreased
The rate of uninsured has gone down significantly in America. In a report by the CDC, the average number of uninsured during the period from January to September 2014 was 11.4 million less than the average in 2010. The latest data from the Gallup-Healthways Well-Being Index, which appeared in an academic article by President Barack Obama in the Journal of the American Medical Association (JAMA), estimate the U.S. adult uninsured rate to be 11% from 17.3 in 2013%, a net reduction of about 15.4 million uninsured adults since 2013.
There are, however, a significant portion of people uninsured: illegal immigrants, citizens eligible for Medicaid but not enrolled, citizens whose insurance rates are more than 8% percent of their annual income, and citizens who simply choose to opt-out of the ACA. The ACA is by no means a perfect law—it was passed into law amidst vehement opposition and controversy.
Obamacare Has Not Reduced Healthcare Spending
Has Obamacare reduced U.S healthcare spending? A 2015 study by the National Health Expenditure Projections projects we spend approximately 3.2 trillion dollars on healthcare and will spend up to 4.5 trillion dollars in 2019, and 5 trillion by 2022. The increase in spending will happen regardless of the ACA, because of our increasingly complex and cumbersome health care system. The U.S spends more on health care than Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain, and Australia combined. If U.S healthcare were an economy, it’d be the 6th largest in the world.
While the ACA alone does not reduce U.S healthcare spending, it’s a step in the right direction. Other new healthcare initiatives like MACRA, which are looking to be just as impactful as Obamacare, are steps toward a reduction in healthcare spending.
The ACA in a Nutshell, What We’ve Learned and What’s to Come
From the data, we can assume that Obamacare is doing well—so far. Are 2.5 years of data predictive of Obamacare’s complete success? Probably not.
However, as we look at the data, we can surmise general trends regarding the ACA:
Overall, the Affordable Care Act has had a positive impact on U.S healthcare: when looking at factors such as quality, affordability, and the rate of the uninsured, the ACA has done its job. More Americans are insured, and it’s overall cheaper. However, it’s not perfect. People in higher income brackets pay more for insurance, and healthcare costs are still going up.
Public opinion holds much sway in a law’s success: If there was ever an indicator of the effect of public opinion on the law, it’s the controversy around the ACA. The ACA could—and should do more for Americans, but because partisanship determines the views of many people, the progress of the ACA has been slow. Perhaps Jonathan Grubber, MIT professor and the key architect of the ACA says it the best:
“…” the most unexpected developments since 2014 is the ongoing opposition to the ACA on both the right and the left, and the vitriolic tone that it continues to take in both public debates and personal attacks. The ACA is now the established law of the land, and given its enormous and ongoing impact on the U.S. healthcare system, it is not going away. Yet the discussion has not followed the natural evolution to a mature consideration of pros, cons, and possible reforms. Rather, it continues to be dominated by ideological position pieces that either propagate misinformation or hold the law to an impossible standard of idealized health care.”
The ACA has set the foundation for huge changes in U.S healthcare delivery: More Americans are now insured in America—millions more. With the way healthcare is managed in the U.S, the current delivery model will be able to handle the increased participation. It will merely balloon costs and spending for both provider and patient. The ACA has set into motion a trend towards reducing the costs of healthcare and increasing the quality of care; we find that in MACRA. As Andy Slavitt, acting administrator of the Centers of Medicaid and Medicare Services notes, “MACRA is the burning platform for progress in care delivery, just as the ACA was in health care coverage. Together, we can make the system radically better.” Present- and post-ACA healthcare has seen a transition towards value-based healthcare for the maximal amount of people.
With the upcoming election, the future of healthcare is up for grabs. What we do know for certain, is healthcare will be electronic-based and will rely on big data. Big data as in using the vast amounts of data we have floating around and transforming it into actionable tasks to improve health outcomes. Look for data to become the key to the betterment of healthcare in the U.S.