The First Five Years of the ACA in Review

The (ACA) turned five in March of this year and the authors of this Health Policy Report in The New England Journal of Medicine describe the milestones that the law has reached so far:

Source: WhiteHouse.gov

Since the implementation of the ACA, 30 million have gained insurance under its various provisions and protections. The an estimated 7 to 16.4 million, with young adults, Hispanics, blacks and those with low incomes benefiting the most. Many worried that the supply of physicians would be unable to meet the growing demand from newly insured patients. However, 75% of Americans seeking new appointments secured one within 4 weeks. Fewer Americans have reported problems with medical bills and financial barriers to obtaining care—the first decrease in over a decade.

The Marketplaces have facilitated impressive numbers: 11.7 million Americans have joined a health plan through the Marketplace, 87% of whom qualified for federal subsidies. Additionally, 10.8 million have enrolled in Medicaid, in large part due to Medicaid expansion in 28 states and the District of Columbia.

Under the ACA, young adults became eligible for coverage under their parents’ policies, and 3 million have opted to do so. The ban against discriminatory practices toward those with preexisting conditions has benefitting an estimated 8-12 million outside the federal marketplace.

In an effort to increase access to primary care, the ACA required state Medicaid programs to pay primary care physicians at Medicare rates for 2 years, resulting in an 8% increase in primary care appointment availability for Medicaid patients among providers already accepting patients. It did not, however, increase the number of physicians who participated in Medicaid. Though many states will revert to baseline reimbursement rates at the end of the 3 years, 15 have decided to extend the increased rate.

A lesser-known effect of the ACA is the additional funding it provided to the National Health Service Corp.: $1.5 billion have been used to support over 14,000 new providers, including 8,900 primary care clinicians in underserved areas.

Abstract

Just over 5 years ago, on March 23, 2010, President Barack Obama signed the Affordable Care Act (ACA) into law. Its enactment may constitute the most important event of the Obama presidency and could fundamentally affect the future of health care in the United States. From a historical perspective, 5 years is a very short time, far too short to assess definitively the effects of the ACA. Still, the 5-year mark seems to be a logical point to pause and take stock of how the ACA has fared to date – to review what we know now of its effect. PMID: 25946142. Blumenthal, D. et al. N Engl J Med 2015; 372:2451-2458

This is the first of a two-part series. Read part two here.