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Springtime for the Affordable Care Act

Posted by John McDonough  March 23, 2014 06:51 PM

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Little darling
It's been a long, cold lonely winter
Little darling
It feels like years since it's been here
Here comes the sun
Here comes the sun, and I say
It's all right

Yes, I know, it's not what you hear every day in the media about the Affordable Care Act (aka: ACA, Obamacare). Yet, on today's 4th anniversary of the ACA's signing on March 23 2010, it ACA signing.jpghappens to be true.

Every day, inch by inch, row by row, the forces for health care justice in the United States are winning. While imposing threats and obstacles still lay ahead, the big ones, especially the U.S. Supreme Court and the 2012 elections, are behind. Yes, setbacks, delays, and screw-ups are yet to be endured, technological, administrative, fiscal, and otherwise. Stuff has happened and will continue to for some time to come.

And yet, we've got to admit, it's getting better. How? Ten ways, of course.

1. Millions of Americans have new quality health insurance coverage and many more will follow:

  • 5 million enrollees and counting in the health insurance marketplaces/exchanges;
  • 3.1 million young adults enrolled in parents' coverage;
  • More than 4 million signed up or renewed for Medicaid;
  • Gallup reports a significant drop recent months in the nation's uninsurance rate from 17.1 to 15.9%, with the biggest drop among households making less than $36,000 per year.

2. Most Americans now have lifelong health security they never had before:

  • 129 million Americans with pre-existing conditions can no longer be denied coverage or charged higher premiums, including 17 million children;
  • For the first time, coverage in the individual market is guaranteed and cannot be denied or rescinded;
  • 105 million Americans no longer have a lifetime or annual dollar limit on their coverage;
  • Individual and employer buyers of private health insurance have saved nearly $5 billion because insurers now must spend at least 80-85 cents of every premium dollar on pure medical costs or rebate the difference to consumers-- $500 million in consumer rebates in summer 2013 alone.

3. Most Americans now have guaranteed health benefits and protections they never had before:

  • For the first time, health plans must cover key essential benefits including maternity care, mental health, prescription drugs, and more;
  • 71 million Americans with private insurance now have access to clinical preventive services with zero co-payments or other cost sharing;
  • 7.3 million seniors have benefited from closing the Medicare prescription drug donut hole;
  • 360,000 small employers have used the ACA's Small Business Health Care Tax Credit to provide health insurance to over 2 million workers.

4. Health care costs, public and private, are more under control, post ACA-signing, than ever before:

  • Health care spending, public and private, has been growing at the lowest rate in 50 years since 2010;
  • The life of the Medicare Hospital Insurance Trust Fund has been extended by at least 10 years, from 2016 to 2026;
  • Medicare enrollees' premiums are flat in 2014, and the last five years have seen lowest rate of premium increases in program history; the Medicare Part B deductible is decreasing in 2014; since 2010, Medicare Advantage premiums have declined on average by 10%. 

5. Medical care delivery in the US is undergoing its most intense period of innovation, experimentation, and reform ever:

  • Medicare hospital readmissions are dropping for the first time ever in the program's history because of the ACA's penalties on hospitals with high readmission rates -- 130,000 fewer readmissions between January 2012 and August 2013;
  • More than 360 Accountable Care Organizations (ACOs) have been established to serve 5.3 million Medicare enrollees, producing better quality care and lower expenditures;
  • A massive $11 billion investment in Community Health Centers over 10 years is helping to ensure primary care for everyone, along with a near tripling of funding and slots in the National Health Service Corps

6. Ignored groups, populations, and needs are seeing huge positive gains, more than ever before. Who? Among them are the mentally ill, racial and ethnic minorities, persons with disabilities, women:

  • Mental health and substance abuse parity benefits for 60 million Americans, one of the nation's largest expansions in behavioral health coverage ever;
  • Women can no longer be charged high premiums because of their gender, and having a baby is no longer a pre-existing medical condition;
  • All the advantages of expanded coverage and benefits disproportionately help racial and ethnic minorities and the disabled who have historically had the least health care protections in American society.

7. Over four years, we have yet to see a Republican alternative to the ACA to meet the nation's health care needs:

  • Repeatedly, since 2010, Republicans have promised to advance a comprehensive replacement plan to the ACA, most recently last January by the House Republican Leader Eric Cantor. Since then? Never mind;
  • House Republicans have voted more than 50 times to repeal all or parts of the ACA, and have yet to hold even one vote for a replacement plan in spite of their control of the House since 2011.
  • Senate Republicans have shown no more coherence than their House counterparts. Senators Coburn, Hatch, and Burr released the outlines of a plan in late January with no accompanying legislative language and contradictions between different versions. Since then, nada.

8. Meanwhile, one by one, states with Republican Governors and/or Legislatures are lining up to join the Medicaid expansion:

  • Already in place: Arizona (Gov. Jan Brewer); Iowa (Gov. Terry Branstad); Nevada (Gov. Brian Sandoval); New Jersey (Gov. Chris Christie); New Mexico (Gov. Susana Martinez); Michigan (Gov. Rick Snyder); North Dakota (Gov. Brian Sandoval); Ohio (Gov. John Kasich);
  • Other states with divided government are lining up to follow, including New Hampshire and Pennsylvania; Arkansas, with a Democratic Governor and Republican Legislature, already is participating.
  • In non-participating states in all sections of the nation, Medicaid expansion is one of the hottest state political issues, and will not die down until states join.

9. Public opinion is firmly against repeal. Fix, don't ditch. That is the conclusion:

  • Though overall support for the ACA is less than tepid, poll after poll shows Americans rejecting repeal. The February 2014 Kaiser Tracking Poll shows the long term trend: 56% of Americans want the law retained and improved, while 31% want it repealed and replaced, or just repealed.

10. Getting past January 1 2014 sealed the deal. The long-term future of the ACA is clear.

  • I said in a January 1, 2014 post that once the ACA's access improvements became fully effective on January 1 2014, there would be no going back. Though there will be modifications, improvements, setbacks and more, the fundamental access guarantees and the work of comprehensive reform are now locked in.

Yes, we will see setbacks ahead, perhaps even short-term loss of the US Senate in 2015-16, with control quickly returning in 2017.

As a nation, we have come too far now to go back.

To the many millions of Americans who have transformed U.S. society for the better by passing, implementing, and sustaining the Affordable Care Act, happy anniversary!

This blog is not written or edited by or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »


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