The Affordable Care Act passed 12 years ago today. President Obama signed it into law March 30, 2010. Let’s look at some of the law’s key goals and evaluate its effectiveness:
Affordable Care – As the law’s title implies, it’s about lowering the cost of health care. Of course in 2010 no one could have foreseen the Covid pandemic, which greatly ramped up healthcare spending in 2020 and 2021, but pandemic spending aside, healthcare costs have not abated. In 2010, national health expenditures were $2.6 trillion. In 2014, they were $3 trillion. In 2019, they were $3.8 trillion. In 2020, they jumped to $4.1 trillion, in part in response to the pandemic.
For individuals and families, this has translated into a constant increase in insurance premiums and healthcare bills. While President Obama promised that his signature law would lower insurance premiums, in reality, the average health insurance premium has increased by 55% since 2010.
Coverage – One of the aims of the ACA was to increase the number of Americans with insurance coverage. It primarily did this through the expansion of the Medicaid safety-net program, which has increased its enrollment by 48% since 2013 (the year before the ACA expansion went into effect).
The Department of Health and Human Services recently released a report saying, “The number of uninsured nonelderly Americans fell from 48 million in 2010 to 28 million in 2016, before rising to 30 million in the first half of 2020.” So while the uninsured population appears to have been reduced by a net 18 million people since the passage of the ACA, the expansion of Medicaid totally swallows this number and then some, with 28 million added to the Medicaid rolls. Yes, it’s a step toward universal coverage, but a bigger step toward government-run health care.
Patient Protection – The ACA didn’t just intend to increase health coverage and decrease costs, but it also included many regulations and mandates intended to protect patients. People with pre-existing conditions purchasing insurance on their own could no longer be denied a plan or charged higher premiums as a result of their health status, even if they had a coverage gap. Young adults could stay on their parents’ plan until the age of 26. These mandates are certainly among the law’s most popular provisions.
But it’s important to note that these requirements created a big shift: They created more costs for health insurance companies, which translated into other changes. Yes, average premiums increased, but health plans also sought to offset costs in other ways, like adopting more narrow networks or offering lower reimbursement for healthcare providers. As a result, many hospitals and doctors chose not to accept ACA plans, restricting options and access for patients. (This has long been a problem in Medicaid as well.) That’s not the patient protection many hoped for.
Finally, one of the consequences of the ACA least often noted is the policy impact. Sure, people analyze the political effect (Republicans and the Tea Party leveraged general sentiment against the law in the 2010 midterms; Democrats capitalized on Republicans’ repeal-and-replace debacle in 2018), but policy-wise the ACA has made any subsequent major reform very difficult.
Even an issue like price transparency, which is overwhelmingly popular (with 90% of Americans in support) doesn’t get the attention it deserves in an environment where the discussion is constantly focused on the downstream effects of the ACA.
Sadly, health policy hasn’t moved forward in the last 12 years. We’ve witnessed some minor changes, yes, but serious reform is still greatly needed, now even more so than before the ACA. The pandemic put great strain on our healthcare system. As we emerge, here’s hoping that better ideas get the traction they deserve.