On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act, a landmark piece of legislation aimed at overhauling health insurance in the United States and ensuring coverage for nearly all Americans. Republican naysayers offered doomsday predictions – that the law would kill jobs, destroy Medicare and ultimately end up being a massive trainwreck. But as we now know, not a single one of those fatalistic projections actually played out.
In fact, just the opposite came true: the Affordable Care Act, also known as ‘Obamacare’, has met or exceeded expectations by just about every possible indicator, including reducing the number of uninsured Americans, slowing the growth of health care costs, improving the quality and affordability of health care, addressing disparities in health care, and transforming the health care system from reactionary to preventative.
There’s still much more to be done to make healthcare affordable, sustainable, and equitable for all, but the Affordable Care Act has laid a strong foundation and made great strides towards achieving the major goals of health care reform. On its fifth anniversary, here’s a look at some of the most important numbers related to the Affordable Care Act:
The Number of Previously Uninsured Americans Who Gained Coverage Under the ACA
The latest figures from the Department of Health and Human Services confirm what several other recent studies have shown: the ACA is achieving one of its core goals of reducing the number of uninsured Americans. A total of 21 million adults have enrolled in new plans since the law was passed in 2010, including 16.4 million previously-uninsured individuals who gained health insurance coverage thanks to Obamacare.
The newly-insured include 2.3 million young adults aged 18 to 26 who were able to remain on their parents’ health insurance, plus another 14.1 million adults who obtained coverage through expansions of the Medicaid program, new marketplace coverage and other sources. Importantly, many of the coverage gains are among groups who have historically had low rates of insurance coverage, such as young adults and people of color.
The rapid expansion in access to insurance under the Affordable Care Act has pushed the nation’s uninsured rate from 20.3 percent in 2012 to 13.2 percent in the first quarter of 2015. That represents a “historic” 35 percent drop in the number of Americans who lack insurance coverage — the “largest reduction in the uninsured in four decades,” according to HHS Secretary Sylvia Burwell.
The Amount of Money Hospitals Saved on Uncompensated Costs Last Year
According to a separate HHS report, released on Monday, U.S. hospitals saved $7.4 billion in uncompensated care costs last year as a result of patient enrollment through Obamacare health insurance exchanges and Medicaid expansion. Before the law, hospitals would take on the cost of treating people who were uninsured or underinsured. In 2013, they provided more than $50 billion in uncompensated care.
The Department of Health and Human Services attributes $5 billion of the decline to Medicaid expansion, which states have the option to participate in. States that did not expand Medicaid reduced costs by 16 percent, and those that did expand the program reduced their costs by 26 percent.
Because of these savings, the ACA is credit with saving the nation’s safety-net hospitals, which treat a disproportionate share of poor and uninsured people and therefore face billions of dollars in unpaid bills. Such facilities had expected to see a drop in uninsured patients seeking treatment, but the change has been faster and deeper than most anticipated— at least in the states that expanded Medicaid.
Number of States (Including the District of Columbia) That Have Expanded Medicaid
One of the goals of the Affordable Care Act is to increase insurance coverage by, among other things, expanding eligibility for Medicaid, the federal health insurance program to nearly all low-income individuals with incomes at or below 138 percent of the federal poverty level — approximately $16,243 a year for an individual and $33,465 for a family of four. Before the ACA, Medicaid eligibility was limited to specific groups of low-income individuals (e.g., children, pregnant women, people with disabilities) and income requirements were generally set at a very low level and varied widely across states. As a result, only 30 percent of poor non-elderly adults qualified for Medicaid coverage in 2012.
The drafters of the law intended for the Medicaid expansion to be implemented nationwide, but a 2012 Supreme Court decision ruled that states could opt out of that provision of the law, giving Republican lawmakers an opportunity to reject the policy in their states. Leading up to the Affordable Care Act’s first enrollment period in October 2013, 24 states said they were moving forward with the expansion while 21 states said they wouldn’t expand the program and six were having ongoing debate about it. As of February 2015, 29 states, including Washington, D.C., had committed to expanding Medicaid, while GOP leaders in 15 states are still refusing the expansion and an additional six are considering expanding the program but haven’t yet followed through, according to the Kaiser Family Foundation.
Under the Affordable Care Act, states can expand Medicaid to include people who make 133 percent of the federal poverty level, which is $16,243 a year for an individual and $33,465 for a family of four. Six additional states are considering Medicaid expansion. The federal government covers 100 percent of Medicaid expansion costs but gradually reduces its contribution to 90 percent by 2020.
According to the Kaiser Family Foundation, which tracks state Medicaid decisions, about 4 million Americans currently fall in the “coverage gap” in states that have not accepted the Medicaid expansion, meaning that their income is above current Medicaid eligibility but below the lower limit to qualify for Marketplace premium tax credits. “These individuals would have been newly-eligible for Medicaid had their state chosen to expand coverage,” Kaiser says.
The Amount of Economic Output the Nation Is Losing by States Not Expanding Medicaid
According to the Department of Health and Human Services, states choosing not to expand their Medicaid programs, as of July 2014, were forgoing an estimated $88 billion in federal funding from 2014 to 2016. They also were reducing the country’s economic output by $66 billion through 2017, according to the president’s Council of Economic Advisers.
Those economy-related figures were released Monday, and also included data from the Kaiser Family Foundation. When people are covered by health insurance, they are more likely to use medical services and to need more providers. According to the data, Texas alone could be forgoing as much as $270 billion in economic impact by 2023.
The Estimated Number of Deaths that Will Be Averted In The Next Three Years Thanks to the ACA
This figure comes from a 2014 study in which researchers compared mortality rates in Massachusetts before and after then-Gov. Mitt Romney (R) signed the state’s health care reform bill into law in 2006 with the mortality rates in similar counties in other states during the same time periods. Their calculations revealed that the mortality rate declined 2.9 percent overall among adults 20 to 64 years old after the law went into effect — which translates into 8.3 fewer deaths per 100,000 people. Based on these calculations, the researchers projected that an average of one death will be prevented for every 830 who gain health insurance. (And given that this program served as a model for the Affordable Care Act, the findings provide an accurate indication of the potential impact of Obamacare on mortality rates nationwide).
When that formula is applied to the Congressional Budget Office’s projections for coverage gains from 2014-2017 (which the ACA is actually exceeding), the result is staggering: the Affordable Care Act will prevent an estimated 31,325 deaths in the next three years alone. (And that doesn’t even include the estimated 50,000 fewer patient deaths in hospitals due to avoidable harms, like an infection or medication error, that are attributed to quality improvement provisions under the ACA).
But when that same predictive formula is applied to the 4 million Americans left in the coverage gap in Republican-led states that refused to expand Medicaid, the outcome is dire: the decision by GOP lawmakers not to expand Medicaid will lead to an estimated 14,458 entirely preventable deaths in the next three years alone.