Affordable Care Act and impact on HealthCare Reform

Thinking about the healthcare reform proposal that passed into law in March 2010

I am making a strong case for why the Affordable Care Act (ACA) is a good law for the millions of Americans who were without any healthcare coverage before the laws passed. Whether we like President Obama or not, we can all agree that Health Care in America needed a major overhaul. The ACA was long overdue in America and previous Presidents tried and failed to make a strong case for health care reform.

“The Affordable Care Act is working, and it is here to stay. So far more than 16 million uninsured Americans have gained health coverage.  Nearly one in three Americans who was uninsured a few years ago is insured today. The uninsured rate in America is the lowest since the US government began to keep such records. With this case behind us, the President reaffirmed his commitment to getting more people covered and making healthcare in America even better and more affordable.“ (1)

First of all, to prove that the Affordable Care Act is working, one has to look at the numbers in the program.

  • 16 million people signed up for private insurance in the Health Insurance Marketplace in 2015. For states that have Federally-Facilitated Marketplaces, 35 percent of those who signed up are under 35 years old and 28 percent are between 18 and 34 years old, virtually the same youth percentage that signed up during the first year when the state of Massachusetts passed its landmark of healthcare reform law.
  • Over 3 million young adults gained coverage thanks to the Affordable Care Act by being able to stay on their parents plan.
  • 3 million more people were enrolled in Medicaid and CHIP as of February 2015, compared to before the Marketplaces opened. Medicaid and CHIP enrollment continues year-round.
  • Over 5 million people are enrolled in plans that meet ACA standards outside the Marketplace, according to a Congressional Budget Office (CBO) estimate. When insurers set premiums for next year, they are required to look at everyone who enrolled in plans that meet ACA standards, both on and off the Marketplace.
  • 5.7 million people will be uninsured in 2016 because 24 States have not expanded Medicaid.

Secondly, Healthcare cost growth is lowest in decades

  • Health care costs are growing at the slowest level on record: Since the law passed, real per capita health care spending is estimated to have grown at the lowest rate on record for any three-year period and less than one-third the long-term historical average stretching back to 1960. This slower growth in spending is reflected in Medicare, Medicaid, and private insurance.
  • Congressional Budget Office (CBO) projects the deficit will shrink more and premiums will be lower than expected: CBO previously estimated that the ACA will reduce the deficit by $1.7 trillion over two decades, and, just this week, CBO concluded that lower-than-expected Marketplace premiums and other recent developments will cut $104 billion from our deficit over the next ten years. The CBO report also projects that lower-than-expected premiums will help to save $5 billion this year, and that lower premiums will persist in the years ahead, remaining 15 percent below projections by 2016 (the only year in which CBO provides a precise estimate).
  • Medicare spending growth is down: Medicare per capita spending is growing at historically low rates.  This week, for the fifth straight year, the CBO reduced its projections for Medicare spending over the next 10 years – this time by $106 billion.  CBO projects that Medicare and Medicaid costs in 2020 will be $180 billion below its 2010 estimates.  Recent economic research suggests that the ACA’s reforms to Medicare may have “spillover effects” that reduce costs and improve quality across the health care system, not just in Medicare.

Thirdly, the security of Health Insurance for millions of middle class families is assured.

  • Up to 129 million Americans with pre-existing conditions – including up to 17 million children – no longer have to worry about being denied health coverage or charged higher premiums because of their health status.
  • 71 million Americans with private insurance have gained coverage for at least one free preventive health care service such as mammograms, birth control, or immunizations in 2011 and 2012.
  • In 2013, 37 million people with Medicare received at least one preventive service at no out of pocket cost.
  • Approximately 60 million Americans have gained expanded mental health and substance use disorder benefits and/or federal parity protections.
  • Since the health care law was enacted, almost 8 million seniors have saved nearly $10 billion on prescription drugs as the health care law closes Medicare’s “donut hole.”
  • 105 million Americans no longer have to worry about having their health benefits cut off after they reach a lifetime limit.

Bright Future

These numbers mean a bright long-term outlook for providers, payers, and employers groups. Healthcare the way we knew it from 1950 is over and it is a new day post 2014 ACA for providers. There was a time when providers called the shots and people counted on their doctors to have all the answers for handling their care. Not anymore. Medicaid reimbursement reductions, capitization, ICD-10, pre-existing conditions mandates, public and private exchanges. The list goes on.

Meanwhile the providers grapple with lower reimbursements for services, high patient demands, and healthcare mandates. The mere thought that the ACA will be repealed so we go back to the pre-ACA days is wishful thinking and that will not happen even with a change of administration to a Republican president. That train has left the station.

The ACA has opened the doors to millions of Americans who now have healthcare and there mere thought of revoking their insurance coverage and sending them back to no coverage will give any presidential candidate a losing start in the elections and a position that spells doom.

While some providers have embraced ACA and have beefed-up their personnel to understand the nuances of ACA and are making the necessary technological changes in the offices, several providers are still in the denial stage and hoping that the bill will be repeal and we all will go back to pre-ACA days. Go tell that to 129 million Americans with pre-existing conditions who now will have to worry about being denied health coverage or charged higher premiums because of their health status.

Reforms in HealthCare has come and gone

If we are anticipating another Healthcare reform in the next fifty years, I think we are in for a rude awakening. I will predict it will not happen. We can only foresee improvements in ACA and making it stronger and better just like Medicaid. History of Medicaid tells us there was a lot of resistance and outside forces wanting to stop it. Medicaid continues to find ways to improve even though it has been around for fifty plus years. ACA is here to stay and we have 16 million new members needing to make an appointment to see a primary care physician. The Affordable Care Act is here to stay with modifications.

References:

1) White House, Weekly Address: The Affordable Care Act is Here to Stay, The Affordable Care Act is Here to Stay – 07/27/2015

2) US Department of Health and Human Services, ASPE – Office of the Assistant Secretary for Planning and Evaluation, Affordable Care Act Research – 09/01/2015

3)Forbes Magazine, Why the Affordable Care Act isn’t here to stay, Why the affordable care act isn’t here to stay, Robert Laszewski, June 29, 2015

4) Supreme Court of the United States Blog, Symposium: A decisive SCOTUS victory for the ACA that may bring an end to endless ACA litigation, Symposium: A decisive SCOTUS victory for the ACA that may bring an end to endless ACA litigation, Timothy Jost, June 25, 2015.