Republican leaders in Congress regularly denounce the 2010 Affordable
Care Act and vow to block money to carry it out or even to repeal it.
Those political attacks ignore the considerable benefits delivered to
millions of people since the law’s enactment three years ago Saturday.
The main elements of the law do not kick in until Jan. 1, 2014, when
many millions of uninsured people will gain coverage. Yet it has already
thrown a lifeline to people at high risk of losing insurance or being
uninsured, including young adults and people with chronic health
problems, and it has made a start toward reforming the costly,
dysfunctional American health care system.
EXPANDING COVERAGE Starting in 2010, all insurers and
employers that offer dependent coverage were required to offer coverage
to dependent children up to age 26. An estimated 6.6 million people ages
19 through 25 have been able to stay on or join their parents’ plans as
result, with more than 3 million previously uninsured young adults
getting health insurance. The law requires private health insurers to
provide free preventive care, without co-pays or deductibles. Some 71
million Americans have received at least one free preventive service,
like a mammogram or a flu shot, and an additional 34 million older
Americans got free preventive services in 2012 under Medicare.
Private insurers are now required to cover children with pre-existing
conditions, which means that an estimated 17 million such children have
been protected against being uninsured.
And more than 107,000 adults have enrolled in a federally run insurance
plan for people with pre-existing conditions. The law also bars insurers
from canceling policies on sick people; previously, 10,000 people a
year had their policies rescinded.
The law appropriated $11 billion over five years to build and operate
community health centers, a major factor in increasing the annual number
of patients served to 21 million, a rise of 3 million from previous
levels. Some $5 billion has been put into a reinsurance program that has
encouraged employers to retain coverage for retirees and their
families; 19 million people benefited with reduced premiums or
cost-sharing.
SAVING CONSUMERS MONEY Private insurers are required by
the law to spend at least 80 to 85 percent of their premium revenues on
medical claims or quality improvements, or they must pay a rebate to
consumers. In 2012, insurers had to pay $1.1 billion in rebates, an
average of $151 per family. Although Republicans contend the law will
drive up insurance premiums, thus far it seems to have reduced them. Any
insurer that wants to increase its premiums by 10 percent or more for
people who buy their own policies must justify the increase to state or
federal officials. As a result, the proportion of rate filings that
sought increases of 10 percent or more fell from 75 percent in 2010 to
34 percent in 2012, and it is expected to be even lower this year. The
average premium increase in 2012 was 30 percent lower than in 2010.
The law also provides for prescription drug discounts to Medicare
beneficiaries. More than 6.3 million older or disabled people have
already saved more than $6.1 billion on prescription drugs since 2010
and will save even more as a gap in coverage, known as the doughnut
hole, is filled in by 2020. And the law ended lifetime dollar limits on
services covered by private plans, a matter of great importance to
people with very high medical costs. Annual limits on what plans will
pay are being phased out.
REINING IN HEALTH CARE COSTS Sharp declines in the
annual growth rate in overall health care spending and in Medicare’s
cost per beneficiary have eased the pressure on federal budgets and on
private insurance premiums. The main factor was presumably the
recession, which made people reluctant to spend on health care, but it
is possible that the focus on reform has led many providers to act more
frugally. The law has reduced unjustified overpayments to private
Medicare Advantage plans, which enroll more than a fifth of all
beneficiaries, and despite fears to the contrary, Medicare Advantage
premiums have fallen by 10 percent and enrollment has risen by 28
percent since the law was passed.
BETTER QUALITY OF CARE One of the most
promising aspects of the health reform act is its focus on improving
quality. The percentage of Medicare patients requiring readmission to
the hospital within 30 days of discharge dropped from an average of 19
percent over the past five years to 17.8 percent in the last half of
2012, an improvement due in large part to penalties imposed by Medicare
for poor performance and financial incentives paid by Medicare to
providers to encourage better coordination of care after a patient
leaves the hospital.
A number of pilot programs in Medicare and Medicaid have been started to
reward quality, to encourage doctors and hospitals to coordinate care,
and to lower costs. If enough of these experiments pan out, they could
transform not only Medicare but the entire health care system.
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