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Obamacare turns five

obama signature on ACA

This week marked the fifth anniversary of the passage of the Affordable Care Act. For the past five years, its opponents have said that this new law would be a disaster– that people wouldn’t buy coverage on the exchanges, that premiums would double or triple, that it would explode the deficit, that it would wreck our healthcare system.

None of these things has come true. Obamacare hasn’t fixed every problem with our healthcare system, but as the law turns five so far it’s doing exactly what it’s supporters claimed it would: expanding coverage to millions of Americans, bringing down costs, and improving the quality of care.

Millions more Americans are covered. This was the main goal of the ACA, and so far the numbers are impressive:

  • 32 million people are covered by Obamacare, either through the exchanges, through plans off the exchanges that can no longer discriminate if they have health conditions, through expanded Medicaid, or because they were allowed to stay on a parent’s plan.
  • 49.9 million people were uninsured in 2010, according to the Census Bureau. That’s now down significantly, to somewhere between 30 million and 40 million people. The Department of Health and Human Services estimates that 16.4 million people who would be uninsured are covered thanks to the new law.
  • Gallup surveys show the uninsured rate has dropped to 12.3%— that’s the lowest it’s been since they started measuring it in 2008 and doesn’t include much of the latest round of open enrollment.
  • It’s been the third fastest expansion of coverage in U.S. history, after only the passage of Medicare and the WWII wage controls (which gave employers a huge incentive to provide health coverage).
  • It’s been especially helpful for minority communities: “For Latino Americans, the uninsured rate fell from 41.8 percent to 29.5 percent. For African Americans, it fell from 22.4 percent to 13.2 percent.” (Those numbers could be even lower– Latinos and African Americans are disproportionately represented in states that refused to expand Medicaid.)
  • Not only do more people have coverage, people like the coverage that they’re getting through Obamacare: 71 percent of those who purchased health insurance on the exchanges rated their plans as either “excellent” or “good.”

Obamacare also improves health coverage for those who aren’t directly covered under it:

Spending on healthcare has slowed dramatically. Even with all of Obamacare’s new spending on Medicaid and premium subsidies, the federal government is now expected to spend less on healthcare than it was before the law was passed:

CBO Obamacare baselines

The CBO now estimates that Obamacare’s subsidies will cost $209 billion less than it had originally projected– largely because premiums on the exchanges have been so low. Premiums were lower than expected in 2014 and rose by just 2% in 2015 (before Obamacare, the norm was around a 10% increase).

And it’s not just on the exchanges– in 2014 the price of hospital care that all insurers pay declined, the first time that’s happened since the government started keeping track in 1998. As California Healthline’s Dan Diamond noted, “The White House’s Council of Economic Advisors put it in the starkest terms: Based on measures of personal consumption, ‘health care inflation is currently running at around 1 percent on a year-over-year basis, a level not seen since 1963.’”

Now we should be clear: it’s hard to tell how much of the slowdown in spending is a result of Obamacare. Health cost growth had already started to decrease before the ACA was passed, and a lot of its most ambitious cost control ideas are still in the pilot phase. On the other hand though, opponents of the law claimed that Obamacare would cause healthcare costs to explode– that simply has not happened.

Improving quality. The third key goal of health reform was to improve the quality of care. Most health researchers say it’s too soon to tell how Obamacare has affected health outcomes, but the early signs are promising.

For example, the provision saying young people could stay on their parents’ insurance until they’re 26 has been in effect since 2010, three years longer than the Medicaid expansion and exchanges. As The New York Times reports, “Young college graduates were far more likely to report excellent health, to have a primary care doctor and to go to the doctor regularly than before the law.”

The ACA also introduced new penalties for hospitals who have high readmission rates for Medicare patients due to complications after the original treatment. The Centers for Medicare and Medicaid have a map tracking the percentage point change in Medicare readmission rates in 2013 compared to the average in the years before the ACA was passed. In most of the country, readmissions are on the decline:

medicare readmission map

And while the Medicaid expansion has only been in place for a year, one study has already found that Medicaid patients with new diabetes diagnoses surged 23% in states that expanded their programs, compared to no increase in states that didn’t. In other words, thanks to Obamacare’s Medicaid expansion, more cases of diabetes are being caught early, when it’s easier to treat, preventing complications down the road.

Meanwhile, researchers from the Brookings Institute have identified five ways Obamacare has improved your care: (1) your physician might be part of a patient care team, (2) you likely have better access to preventive care and wellness programs, (3) you may have better access to care on evenings and weekends, (4) chances are your health info is now being stored electronically instead of on paper, and (5) you can access care remotely, wherever you are. These are all things that studies have shown lead to better health outcomes.

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