There has been discussion about the need to “fix” Obamacare. While some improvements can likely be made, I contend the program has been fundamentally successful.
The Affordable Care Act (ACA) (commonly referred to as Obamacare) had three lofty objectives: increase health insurance coverage, reduce rising healthcare costs, and improve the quality of care provided. Eight years later how has it fared?
Number of uninsured Fell Dramatically
In 2010, when the ACA was passed the number of Americans under age 65 without health insurance was 48.3 million (CDC NHIS), By 2016, this number had fallen to 10.3 million ( a reduction of 38 million). Over this time period the economy improved substantially and 13.8 million individuals obtained insurance via private sources (including employer-provided insurance and young people staying on their parent’s plans to age 26. The expansion of Medicaid, a program within the ACA, extended insurance to another 12.3 million people. Finally, approximately 12 million Americans obtained insurance through the exchanges. Overall, the number of insured Americans fell by 79 percent.
The rate of cost increase has slowed
With regard to costs, the evidence suggests that Obamacare has helped slow the rate of increase. Using the National Health Expenditure Accounts (NHEA) which are the official estimates of total health care spending in the United States, I examine healthcare costs over the past 18 years. As the graphic below shows, since the passage of the ACA, cost increases have been slower than in the 10 years prior (CMS), dropping from a 8.1 percent rate of increase to 4.1 percent (a 46 percent drop). However, it is difficult to attribute all cost containment to the the ACA. Many of its provisions did not go into effect until 2014 and there was an uptick at that time but it appears to have come back down by 2016.
Increased Use of preventive services suggests better quality
Finally, the ACA seeks to increase quality of care, Quality of care is difficult to measure in a meaningful way but providing preventive care is clearly a component of good quality care. Nationally, Americans use preventive services at about half the recommended rate (CDC1). The ACA extended coverage to include preventive services and in parallel use of these services increased. As CDC reports (CDC2), between 2008 and 2015, receipt of the full series of human papillomavirus (HPV) vaccine for adolescents aged 13–17
increased among females from 17.9% to 41.9% . Similarly, between 2010 and 2015, the percentage of adults aged 18 and over who had received an influenza vaccination in the past 12 months increased from 35.8% to 43.2%. Finally, between 2000 and 2015, the percent of adults aged 50–75 with a colorectal cancer test or procedure approximately doubled .