Assessing the Affordable Care Act

Talk to one person and the Patient Protection and Affordable Care Act (ACA) will be described as the most significant improvement to U.S. healthcare in decades. Talk to another and you may hear about how it’s a disaster for the country.

Since the ACA was passed in 2010, straight talk on the law has been hard to come by. Predictions about the ACA’s ability to save or destroy the U.S. have been based more often on politics than honest statistics.

With a piece of legislation as large as the ACA, it’s too early to offer a verdict on just what the impact of the law has been and will be going forward, however a few of the top stories from the past month have looked at some trends in the post-ACA world.

A study published in JAMA on July 28, for example, found improvements to insurance coverage, access to care and self-reported health since open enrollment on the ACA-created health insurance exchanges began in October 2013.

Researchers described the ACA as resulting in the largest reduction in the uninsured rate in more than 40 years, with the uninsured rate falling by 7.9 percentage points. This equates to an additional 15.8 million adults receiving coverage.

The study also showed seven million more people gained access to a personal physician due to the ACA. Surveys from both before open enrollment and after indicated 6.8 million additional adults said they were in excellent, very good or good health following ACA expansion.

However, expanding coverage rates among Americans comes at a cost, literally. An annual report from actuaries at the Centers for Medicare & Medicaid Services (CMS), published online in Health Affairs on July 28, showed that national health spending increased 5.5 percent in 2014, the first time in six years that spending increased more than 5 percent.

CMS estimated that health spending would grow an average of 5.8 percent per year through 2024 due to a few factors, including the expansion of health coverage.

What do physicians think? The latest polling comes from a survey conducted by the American Association for Physician Leadership and the Navigant Center for Healthcare Research and Policy Analysis. Results show docs leaning toward the pro-ACA camp.

Of the nearly 2,400 members of the association who completed the survey, 55 percent said they agreed or strongly agreed that the ACA has “more good than bad.” Additionally, 57 percent agreed that accountable care organizations—a staple of value-based care championed by the reform law—will be a permanent model for risk-sharing with payers going forward.

These figures are intriguing, but it’s only a start. Much more will be learned about the impact of these reform efforts in the years ahead. The story of the ACA is just beginning.

-Evan Godt
Editorial Director – Health Imaging