In March of 2010, President Barack Obama signed the Affordable Care Act (ACA) into law, putting in place comprehensive reforms aimed to improve and expand access to affordable health coverage for all Americans. In addition, the law is meant to provide consumer protections and prevent restrictive and abusive practices by health insurance companies. It is important to note that although the ACA has put into place major reforms to provide broader coverage, the U.S. remains one of the few exceptions among industrialized nations that provide universal health care.
The ACA turns six on March 23, 2016, and it’s been a rocky road. Its inception was marred by a fitful launch of healthcare.gov, the federal website that was designated to also serve 36 state insurance exchanges. Performance issues and repairs to healthcare.gov cost taxpayers tens of millions of dollars more than originally expected, fueling contentious political debates around the utility and benefits of the ACA. In contrast, the law has resulted in the U.S. uninsured rate dipping below 10 percent for the first time ever, with coverage now reaching 20 million people. Six years later, we mark this milestone by reviewing the facts and checking in on current reports and perspectives surrounding the ACA.
What were major changes put into effect by the ACA?
- The start of the Affordable Care Act’s individual mandate, meaning (most) Americans must have health insurance or pay a penalty
- Consumer choice: Citizens can select and purchase insurance on state exchanges and the federal marketplace
- Subsidies and tax credits available that can help lower premiums for qualifying Americans
- Guaranteed availability of coverage; protection from denial for those with pre-existing conditions, also making rescinding coverage for sick patients illegal
- Expanded coverage eliminating out-of-pocket costs for preventative care such as flu shots and birth control; mandatory essential health benefits for all ACA plans
- Expansion of coverage of dependents up to age 26
Studying ACA Impact
As the Affordable Care act evolves and grows, here is what researchers and experts are saying about its impact thus far and the impact changes may have on public health professionals in a variety of fields.
Kaiser Family Foundation: Analysis of 2016 Premium Changes and Insurer Participation in ACA Health Insurance Marketplaces
“The ACA’s rate review provision requires premium increases over 10 percent to be made public. As a number of individual market insurers are requesting 2016 increases well above 10 percent, concern has been raised over the affordability of premiums in the coming year. As was the case last year, the plans that had the lowest premiums in 2015 were usually no longer one of the two lowest-cost silver plans in 2016. This underscores the importance of enrollees actively shopping each open-enrollment period.”
Impact on Public Health Professionals: In order to effectively inform consumers, those working in health advocacy and education must keep up to date on yearly ACA plan changes and maintain an understanding of the complexities of health benefits.
NPR and the Harvard School of Public Health: Patient’s Perspectives Health Care Survey
“Americans have mixed feelings on the state- and personal-level effects of the Affordable Care Act. The proportion of U.S. adults who believe the law helped people in their state approximately equals the proportion of people who believe national health reform hurt their fellow state residents. On a personal level, most Americans do not believe the law directly affected them. Among those who do, however, more believe the law directly hurt them than helped them.”
Impact on Public Health Professionals: Despite increasing health coverage, key issues persist such as gaps in health access and a dependency on emergency versus preventative care, especially amongst the poor. The need for innovative public health interventions to ensure healthy communities across socio-economic level continues.
The Commonwealth Fund Five-Year Study: The Affordable Care Act and the U.S. Economy
“There is no evidence that the ACA has had a negative impact on economic growth or jobs or that its reforms have undermined full-time employment. To the contrary, evidence indicates that the ACA has likely acted as an economic stimulus, in part by freeing up private and public resources for investment in jobs and production capacity. Moreover, the law’s payment and other cost-related reforms appear to have contributed to the marked slowdown in health spending growth seen in recent years.”
Impact on Public Health Professionals: To soon to tell, though a slowdown in health spending could mean an impact on jobs for those working in direct-care facilities such as hospitals and clinics.
U.S. News and World Report: More Small Business Owners to Offer Coverage, Face Increased Compliance
“Small businesses will have to shell out more money for health care in 2016. ‘Small business have to figure out who is going to cover this increase. Will the employer continue to cover it, or will more cost be shifted to the employee?’”
Impact on Public Health Professionals: The need for businesses and employees alike to better understand ACA health plans—and how to budget for this extra cost—points to an increasing demand for effective tools to educate the public. Public health professionals will be a necessary resource to help small-business owners and their employees navigate the different options and their respective costs.
PwC Health Research Institute: ACA Exchange Insights Report
Three years in, the ACA marketplace shows modest premium growth, fewer plan options and continued competition. “Premiums for the second-lowest-cost silver plans are creeping up, seeing their biggest increase in year three. However—despite concerns about dramatic rate hikes—overall growth still holds steady with that in the employer market. Carriers also are reducing the number of plans they sell and are steering away from platinum plans altogether.”
Impact on Public Health Professionals: Those working for health insurance companies may experience volatility, as the playing field shifts and consumer choice and government regulations dictate the success and profitability of health insurance providers.
What is your perspective on the Affordable Care Act? Have you had a positive or negative experience purchasing health insurance through the healthcare marketplace? Tell us about it in the comments section below.