Others could be implemented by the administration, state law, or by private parties. Some solutions would require federal legislation. This report identifies problems and suggests potential solutions. Perhaps the most serious problem-which this report will address repeatedly-is the inadequacy of the ACA’s subsidies and regulatory structures to address the problems of low-income Americans, for whom merely meeting the costs of day-to-day essentials is a continuing challenge, and for whom even modest monthly insurance premiums and cost-sharing are often serious barriers to health coverage and care. Many of the remaining challenges in health care reform reflect the inherent complexities and path-dependency of the American system and were beyond the reach of any politically feasible reform. The ACA undertook from the beginning an ambitious reform agenda, but some of its approaches have turned out to be ineffective, poorly targeted, or not ambitious enough to address deeply rooted problems. Incentives and new payment arrangements enacted under the ACA played an important part in these improvements.ĭespite these accomplishments, our health care system continues to face serious challenges, some traceable to flaws and weaknesses in the ACA. Recent data on hospital infection, preventive care, and avoidable hospital readmission (alongside continued striking progress in age-adjusted survival) suggest that American medical care is better 11 and safer 12 than it has ever been.8 Although 2015–16 premium growth varies by location and plan, average premium growth for the benchmark second-lowest cost silver plan was 7.2 percent, 9 well below average premium growth in the three years preceding the ACA. 7 Between 20, the population-weighted national average premium increase in the lowest-cost silver plan was 2.9 percent. Average monthly premiums on the new marketplaces are proving reasonable, with manageable premium growth in most major markets since the ACA’s enactment.State expenditures associated with the ACA have also been restrained, with lower Medicaid expenditure growth observed within states that embraced the ACA’s Medicaid expansion than in their non-expansion counterparts. CBO now projects that Medicare will spend only $574 billion in that same year, 24 percent less than predicted before the ACA (see Figure 2). In 2008, for example, CBO’s projected that Medicare’s net mandatory outlays would be $759 billion in calendar year 2018. 6 Medicare expenditure growth has fallen markedly below original projections. 5 Between January and March 2015 alone, the Congressional Budget Office (CBO) and the Joint Committee on Taxation reduced their estimated costs of ACA’s 2015–2025 coverage provisions by $142 billion. The ACA is now projected to reduce budget deficits far more than was projected at the bill’s passage. Public health care expenditure growth has markedly slowed, which suggests the change extends beyond transient economic patterns associated with the Great Recession.4 Economic conditions have contributed to this favorable trend, but the ACA also played a helpful role. Health care prices have grown at an annual rate of 1.6 percent since the ACA was adopted, roughly in line with overall inflation and the slowest rate for any comparable period for the past half century.Hospital expenditures for uncompensated care have plummeted by $7.4 billion, with the decline particularly great in states that embrace the ACA’s Medicaid expansion.2 The percentage of Americans under the age of 65 who lack health insurance is now lower than at any point in the past five decades (see Figure 1). 1 This is a striking reduction, especially in light of the refusal of twenty states to implement the ACA’s Medicaid expansion, one of the ACA’s core coverage strategies. The ACA has reduced the ranks of the uninsured by an estimated 17.6 million since it was adopted in 2010.The ACA has already achieved many significant accomplishments: Indeed the period from 2010 to 2015 may be the most successful five years in the modern history of health policy. ![]() Despite uncompromising political opposition widespread public misunderstanding serious underfunding numerous lawsuits, three of which have so far made it to the Supreme Court and major technological failures at launch, the ACA has largely succeeded in its principal task-enrolling tens of millions of people in health insurance coverage. Though not yet six years old, the Affordable Care Act (ACA) has accumulated a record of remarkable accomplishments.
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