Today marks the 10th anniversary of the opening of the Affordable Care Act’s portal, Healthcare.gov. Ignoring the disastrous first few days, as good an illustration of the federal government’s shortcomings in managing technology as any, how would we evaluate the success of the Affordable Care Act (ACA)?
According to the Department of Health and Human Services (HHS), the objectives of the ACA are:
- Make affordable health insurance available to more people. The law provides consumers with subsidies (“premium tax creditsâ€) that lower costs for households with incomes between 100% and 400% of the federal poverty level (FPL).
- Expand the Medicaid program to cover all adults with income below 138% of the FPL. Not all states have expanded their Medicaid programs.
- Support innovative medical care delivery methods designed to lower the costs of health care generally.
Since 2012 the percentage of Americans with some form of healthcare insurance has increased from 84.6% to 92.1%. The percentage of people covered by Medicaid has increased from about 12% to 18.8%. However, according to Peterson-KFF per capita spending on health care has increased from $3,152.30 in 2012 to $4,255.10 in 2021 (in constant 2021 dollars). On that basis I think we should consider the ACA a qualified success. That can be explained a variety of ways but most of those ways were known in 2012 and the opposite was claimed. The bottom line is that costs have increased while life expectancy has decreased.
Where to go from here? Will we be able to continue spending a greater percentage of the national income on healthcare indefinitely? It seems unlikely that covering the remaining 8% of people under Medicaid will reduce costs. Will it increase life expectancy?
The industry I work in is primarily contract (1099) employees, so I know many people without employer-provided health insurance. Obamacare has largely been positive for them simply because they buy health insurance, and most receive some sort of subsidy thanks to the 400% poverty threshold. But the plans are still extremely expensive.
Since the ACA health spending has grown at a bit lower percentage over general spending than it has in the past. As I recently noted in the last couple of years it has grown at a rate slower than inflation.
Life expectancy is down recently due to covid but pre covid it was largely drugs/alcohol and suicide. We handle drugs as mostly a legal issue. We dont spend a lot of effort on mental health issues so its off in its own world. Also, the increase in deaths, IIRC, has been concentrated in states that were late to accept or still dont have expanded Medicare under the ACA. It’s especially true in infant and maternal mortality rates which also overlaps with states that are banning abortion.
Steve
Unless you need to use it, Obamacare is great. The subsidies do not help with deductibles and co-pays. Basically, you get a cheap policy that you cannot use.