Affordable Care Act Achieved

The Patient Protection and Affordable Care Act (ACA) has 3 main objectives:

1. to reform the private insurance market—especially for individuals and small-group purchasers,
2. to expand Medicaid to the working poor with income up to 133% of the federal poverty level, and
3. to change the way that medical decisions are made. All 3 objectives rely primarily on private choices rather than government regulation and are rooted in expectations of rational decision making shaped by incentives but unfettered by other constraints. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767707/, n.d.)

The implicit assumption is that individuals and groups will act within these reforms to produce a valued good (access to medical care) at an appropriate price (what it would cost an efficient provider) financed by fair risk sharing (spreading the cost of necessary services across a large pool). The result will be Affordable Care. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767707/, n.d.)

Although the ACA may go far toward this goal, the assumptions of efficient and fair mechanisms of interchange do not represent reality in many respects.

There are many impediments to the underlying choices of all players. As a result, it will be necessary to correct for market failure if this essentially private approach to public policy is to succeed. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767707/, n.d.)

The Affordable Care Act has made significant progress toward solving long-standing challenges facing the US health care system related to access, affordability, and quality of care. Since the Affordable Care Act became law, the uninsured rate has declined by 43%, from 16.

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0% in 2010 to 9.1% in 2015, primarily because of the law’s reforms. Research has documented accompanying improvements in access to care (for example, an estimated reduction in the share of nonelderly adults unable to afford care of 5.5 percentage points), financial security (for example, an estimated reduction in debts sent to collection of $600–$1000 per person gaining Medicaid coverage), and health (for example, an estimated reduction in the share of nonelderly adults reporting fair or poor health of 3.4 percentage points). (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5069435/, n.d.)

The law has also begun the process of transforming health care payment systems, with an estimated 30% of traditional Medicare payments now flowing through alternative payment models like bundled payments or accountable care organizations. These and related reforms have contributed to a sustained period of slow growth in per-enrollee health care spending and improvements in health care quality. Despite this progress, major opportunities to improve the health care system remain. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5069435/, n.d.)

Policy makers should build on progress made by the Affordable Care Act by continuing to implement the Health Insurance Marketplaces and delivery system reform, increasing federal financial assistance for Marketplace enrollees, introducing a public plan option in areas lacking individual market competition, and taking actions to reduce prescription drug costs. Although partisanship and special interest opposition remain, experience with the Affordable Care Act demonstrates that positive change is achievable on some of the nation’s most complex challenges. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5069435/, n.d.)