What Have We Learned About the PPACA Since It Was Implemented?
In 2015, the PPACA will achieve its 5-year milestone. Since the inception of PPACA, many changes have occurred in the way health care is delivered and purchased by consumers. This week gives you an opportunity for introspective analysis. How well is the PPACA actually working? Is it meeting public expectations? Compare what the research literature says with your own experiences and observations. This should form the basis for your Discussion, with a focus on what has been achieved to date and what can still be improved.
To Prepare for This Discussion:
Read the Levitt article on how well the PPACA is working, as well as articles in this week’s Learning Resources regarding the PPACA. Consider whether or not you agree with the Levitt article, and why. As Levitt asserts, there are always differences of opinion about the law and policy issues. Consider each point discussed by Levitt,
including Creating an easy online access for people to get information about health insurance options,
Making insurance more accessible and affordable, and
Reducing the number of Americans who are uninsured.
Posta cohesive response to the following:
Provide an evaluation (or assessment) of whether or not you agree with Levitt, the author of the article, making sure to address the specific points he outlines, including the online process for obtaining health care information, accessibility, affordability, and reducing the number of uninsured. Support your position by utilizing a minimum of two peer-reviewed resources from the academic literature.
HOME›MEDICAL PRACTICE›HEALTH POLICY›JAMA FORUM: HOW WELL IS THE AFFORDABLE CARE ACTWORKING?
JAMA Forum: How Well Is the Affordable Care ActWorking?
BYLARRY LEVITT, MPPonJULY 9, 2014
Larry Levitt, MPP
The American people are stilldividedin their views of the Affordable Care Act (ACA), which is perhaps not surprising given how partisan the debate has been and the fundamental ideological differences in the country about the appropriate role for government in health care, as in other spheres. There are legitimate differences of opinion about the law, just as there are about any important policy issue.
But the politics of the ACA often get confused with the question of whether the law is working as intended, whatever one may think of the wisdom of those intentions. That is largely a factual question, though facts about the ACA are often blurred when looked at through ideologically tinted lenses.
To be sure, there is still plenty that remains unknown about the ACA, and it will take years for the law to fully play out and to get a complete evidence-based reckoning of how it is working. Here, though, is my initial take on how well the ACA is accomplishing so far what it set out to do:
1. Creating an easy online process for people to get information about their health insurance options and sign up.
A centerpiece of the ACA was the creation of new health insurance exchanges (now called marketplaces) that would allow people to compare plans and easily apply for coverage and income-based financial assistance online. This, needless to say, did not go quite as planned. Most statesdecidednot to set up marketplaces, leaving it to the federal government.Healthcare.gov, the online home for the federal marketplace, was largely nonfunctional when open enrollment began last October.
It was subsequently fixed in a widely-publicized “tech surge,” yet challenges still remain. For example, many people had information on their applications that was inconsistent with what was shown in government databases, and theprocess for resolving those inconsistencieshas been slow. State-operated marketplaces were a mixed bag, with some (eg, California, Kentucky, Connecticut, Washington, Rhode Island) working reasonably well by most accounts, and others facing significant technological problems (eg, Oregon, Hawaii, Maryland, Massachusetts). However, even with these technological missteps,8 million people signed upfor a marketplace plan by the end of the open enrollment period, beating expectations (withat least 80%of them likely having paid their first month’s premium and actually enrolling). And, anestimated 6 million more peopleare enrolled in Medicaid since the third quarter of last year.
2. Making insurance more accessible.
One complaint with the individual insurance market that the ACA sought to address wasdiscriminationagainst people with preexisting health conditions, who previously were either denied coverage altogether or charged higher premiums. People with expensive illnesses still face some access challenges—for example,very high out-of-pocket costs for certain specialty drugs—but in general, individuals with preexisting conditions now have no trouble getting access to insurance and they pay the same premiums as people who are healthy. This is significant because abouthalf (49%) of adults younger than 65years say they or someone in their household has a preexisting condition.
3. Making insurance more affordable.
This is perhaps the hardest of the ACA’s aims to sort out. In part, there is no easy answer because the effect varies so much, depending on individual circumstances. The preponderance of the evidence, however, suggests that insurance is now more affordable on average than it was before the ACA’s implementation:
- Limits on the share of premiums that insurers can devote to administrative costs and profits have led torebates for consumers and businesses and lower premiumsthan would have otherwise been the case.
- Although there was much controversy last fall about people who experienced cancellation of individual insurance policies that didn’t include services defined by the ACA as essential or excluded people with preexisting conditions, and who then saw their premiums increase under the ACA, a recentKaiser Family Foundation (KFF) surveyof people in the individual insurance market shows that just as many people who switched to ACA-compliant plans saw their premiums decrease.
- Newfederal datashows that 87% of the people signing up for coverage in the federal marketplace qualify for income-based premium subsidies that lower their average premium from $346 per month to $82, a reduction of XXXXXXXXXX%.
4. Reducing the number of Americans who are uninsured.
This is perhaps the ultimate test of whether the ACA is working as intended: Is it significantly diminishing the 48 million Americans who were previously uninsured? It will bequite some timebefore we have the results of large federal surveys that can be used to measure changes in the number of people uninsured. Andprojections from the Congressional Budget Officesuggest that it will take several years for the full effects of the ACA on insurance coverage to ramp up.
But we are already starting to see signs of a decreasing number of uninsured individuals. A large tracking poll fromGallupshows that the percentage of adults who say they are uninsured is down from 17.1% in the fourth quarter of 2013 to 13.4% today. Earlier surveys from theUrban InstituteandRANDalso show declines. And the recent Kaiser Family Foundation individual insurance market survey shows that nearly 6 in 10 of those enrolling in health insurance marketplaces were previously uninsured.
For years we’ve debated the ACA based on hypotheticals and spin. Now, as the law is being implemented, facts are starting to enter the discussion, and that’s a welcome development. Of course, because the ACA—like any complex law—has both losers and winners, it will no doubt continue to remain controversial for the foreseeable future, even if it accomplishes what it’s supposed to.
About the author:Larry Levitt, MPP, is Senior Vice President for Special Initiatives at theKaiser Family Foundationand Senior Advisor to the President of the Foundation. Among other duties, he is Co-Executive Director of the Kaiser Initiative on Health Reform and Private Insurance.
About TheJAMAForum:JAMAhas assembled a team of leading scholars, including health economists, health policy experts, and legal scholars, to provide expert commentary and insight into news that involves the intersection of health policy and politics, economics, and the law. EachJAMAForum entry expresses the opinions of the author but does not necessarily reflect the views or opinions ofJAMA, the editorial staff, or the American Medical Association. More information is availablehereandhere.