Access to Quality, Affordable Health Care: Progress and Promise of the Affordable Care Act and Other Administration Efforts
Today, President Obama will travel to Miami Dade College in Miami, Florida to deliver remarks about the progress we’ve made to improve our health care system, largely because of the Affordable Care Act (ACA), and what more can be done to advance affordable, accessible and quality health care. He will discuss the upcoming open enrollment period for the Health Insurance Marketplace, which runs from November 1 through January 31, as well as the Administration’s efforts this year to sign up young adults for coverage, who compose a disproportionate share of the remaining uninsured. Miami Dade College has served as a nationwide model for its work with its surrounding community to enroll eligible Americans in health coverage. And the President will reflect on the transformation in health care over the last seven-plus years, including system-wide reforms that are putting patients at the center of their own care and laying the foundation for a generation of medical advances.
Eight years ago, candidate Obama promised that he would make quality, affordable health care not a privilege, but a right. America was one of the last industrialized nations where this wasn’t already the case. Tens of millions of Americans couldn’t get health insurance, while others were forced to declare bankruptcy when they incurred crippling medical debt because of an accident or an unexpected diagnosis. High and rising health care costs placed serious burdens on our businesses, workers and economy, and threatened the future of Medicare. And our health care system too often failed to focus on patients, often waiting until Americans were sick to treat them rather than focusing on keeping them healthy.
After decades of trying by presidents of both parties, President Obama made health care reform a reality. Because of the coverage expansions enacted in the ACA, an estimated 20 million adults have gained health insurance coverage as of early 2016. Children have also seen major coverage gains during this Administration, thanks in large part to the ACA and the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA). The uninsured rate among children has fallen by almost half since 2008, resulting in more than 3 million additional children having health insurance, according to a new analysis published today by the Council of Economic Advisers. The uninsured rate for people of all ages now stands at 8.6 percent, the lowest level on record.
Even as we have achieved historic coverage gains, the outlook for health care spending has improved dramatically. Over the ACA’s first decade, we are now on track to spend $2.6 trillion less than was projected without the ACA back in 2010.
Thanks in part to the ACA’s focus on reducing costs and inefficiencies, health care prices have risen at the slowest rate in 50 years since the law passed, which will benefit all of us for years to come. For example, as a result of low premium growth in employer-sponsored coverage, the average premium for employer-sponsored family coverage in 2016 was nearly $3,600 lower than if premium growth since 2010 had matched the average premium growth rate recorded over the decade preceding the ACA. Slower growth compared to before the law was enacted has helped our economy, businesses, workers and state governments.
The ACA is significantly improving the quality of patient care throughout the health care system. For example, the law provides incentives to hospitals in Medicare to improve quality and reduce avoidable hospital readmissions. Hospital-acquired conditions have fallen since 2010, saving 87,000 lives and $20 billion in health care costs.
The ACA also catalyzed the development of Medicare value-based payment models aimed at transforming our health care delivery system through improved patient outcomes and reduced costs. The bipartisan Medicare physician payment reforms passed by Congress as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) builds on the ACA’s work by focusing on the quality and efficiency of care provided to beneficiaries and creating incentives for clinicians to participate in value-based models.
Across the country, Administration policies have significantly improved access to health care, the affordability of care, and the quality of care since 2009. But there is more work to be done. Congress should support investments in targeted research and technologies to advance the Cancer Moonshot, the Precision Medicine Initiative, and the BRAIN Initiative. The Administration is tackling the opioid epidemic through administrative actions but also has asked Congress for $1 billion in resources for states to help people get much-needed treatment.
In addition, the President believes that there are common-sense ways to continue to improve the ACA. This includes working with the 19 states like Florida that have yet to expand Medicaid, taking additional actions to reduce the costs of prescription drugs, increasing financial support for people still struggling with health insurance bills, and ensuring a choice of health insurance issuers such as through a public plan fallback option. As recent experience shows, we can make a positive difference in our health system when we work together across party lines to do so.
Health Care in America: Improved Access to Care
Millions more Americans have health insurance. Thanks to the Affordable Care Act, an estimated 20 million adults have gained health insurance coverage. The ACA and CHIPRA have also helped cut the uninsured rate among children by almost half, resulting in more than 3 million additional children having health insurance coverage.
- Overall, 8.6 percent of Americans lacked health insurance in the first quarter of 2016, the lowest rate on record.
- Among African American adults, the uninsured rate declined by 53 percent (11.8 percentage points) since 2013, resulting in 3 million people gaining coverage.
- Among Latino adults, the uninsured rate dropped by 27 percent (11.3 percentage points) since 2013, resulting in 4 million people gaining coverage.
- The gains for women have been particularly rapid: the reduction in the uninsured rate since 2013 has been 13 percent larger than the reduction for men.
- Among young adults, the uninsured rate has dropped by 47 percent (12.1 percentage points) since 2013. Together with pre-2013 gains due to young adults’ option to remain on a parent’s plan, 6.1 million young adults have gained coverage.
- Since implementation of the Affordable Care Act, there has been a substantial reduction in the uninsured rate across all income levels, age groups, races and ethnicities, and geographic areas.
- The ACA prohibits coverage denials and reduced benefits based on health status, protecting as many as 129 million Americans who have some type of pre-existing health condition, including up to 19 million children.
- The law also eliminates lifetime and annual limits on insurance coverage and establishes annual limits on out-of-pocket spending on essential health benefits, benefiting 105 million Americans, including 39.5 million women and nearly 28 million children.
The ACA provides generous federal support to states that expand Medicaid to all adults with incomes under 133 percent of the federal poverty level. In the 31 states and the District of Columbia that have already expanded Medicaid, 4.4 million uninsured people will gain coverage. If the remaining states expand Medicaid, over 4 million more uninsured people would gain coverage.
- Medicaid expansion has improved individuals’ financial well-being, reducing debt in collection in states that have expanded by an estimated $600-$1,000 per individual gaining Medicaid coverage.
- Medicaid expansion also makes premiums more affordable for people who buy coverage on the individual market. Marketplace premiums are an estimated 7 percent lower in expansion states than non-expansion states.
- The ACA establishes a system of state and federal Health Insurance Exchanges, or Marketplaces, to make it easier for individuals and small-business employees to purchase health plans at affordable prices. During the most recent open enrollment period, 12.7 million people selected a plan through the Marketplace, and more than 400,000 people signed up for Basic Health Programs, state-based programs supported by the Affordable Care Act that provide health insurance coverage to low-income individuals who would generally otherwise be eligible to buy qualified health plans on the Marketplace.
- The ACA created a temporary high-risk pool program to cover uninsured people with pre-existing conditions prior to 2014 reforms, which helped more than 130,000 people.
- The ACA creates health plan disclosure requirements and simple, standardized summaries so over 170 million Americans can better understand coverage information and compare benefits.
Health Care in America: More Affordable Care
The ACA’s tax credits have helped millions of Americans who otherwise might not be able to afford it sign up for health coverage through the Health Insurance Marketplace.
- In 2015, there were 12 million fewer Americans in families that had problems paying medical bills compared to 2011.
- It also requires health insurers to provide consumers with rebates if the amount they spend on health benefits and quality of care, as opposed to advertising and marketing, is too low. Last year, 5.5 million consumers received nearly $470 million in rebates. Since this requirement was put in place in 2011 through 2014, more than $2.4 billion in total refunds will have been paid to consumers.
- The ACA eliminates out-of-pocket costs for preventive services like immunizations, certain cancer screenings, contraception, reproductive counseling, obesity screening, and behavioral assessments for children. This coverage is guaranteed for more than 137 million Americans including 55 million women.
- The ACA eliminates out-of-pocket costs for 39 million Medicare beneficiaries for preventive services like cancer screenings, bone-mass measurements, annual physicals, and smoking cessation.
- It phases out the “donut hole” coverage gap for over 11 million Medicare prescription drug beneficiaries, who have saved an average of more than $2,000 per beneficiary through July 2016.
The ACA takes steps to slow the growth of health care spending.
- Relative to the projections the Congressional Budget Office (CBO) issued just before President Obama took office, CBO now projects Medicare to spend 20 percent, or about $160 billion, less in 2019 alone.
- Medicare’s Trustees project that the program’s hospital insurance trust fund will remain solvent until 2028, 11 years later than the last projection before the ACA became law.
- The nation as a whole is projected to spend $2.6 trillion less on health care over the ACA’s first decade than was predicted prior to the ACA’s enactment.
- The law creates Accountable Care Organizations consisting of doctors and other health-care providers who come together to provide coordinated, high-quality care at lower costs to their Medicare patients. Over 470 ACOs are serving nearly 8.9 million Medicare beneficiaries nationwide.
- And it pays Medicare Advantage plans more accurately, and requires Medicare Advantage plans to spend at least 85 percent of Medicare revenue on patient care. Medicare Advantage enrollment is projected to have grown over 60 percent from 2010 through 2017 to 18.5 million, while premiums are projected to decline by 13 percent.
Health Care in America: Improved Quality and Accountability to You
- The ACA provides incentives to hospitals in Medicare to reduce hospital-acquired infections and avoidable readmissions. Hospital-acquired conditions have fallen 17 percent since 2010, saving 87,000 lives and $20 billion in health care costs, and the rate of one common deadly hospital acquired infection, central-line blood stream infections, fell by 50 percent from 2008 to 2014 nationwide.
We're not done. Other legislative and executive actions are continuing to advance the cause of effective, accountable and affordable health care. This includes:
- Advancing innovative care delivery models and value-based payments in Medicare and Medicaid. The Administration set goals of tying 30 percent of traditional Medicare payments to alternative payment models by the end of 2016 and 50 percent by the end of 2018, and met its 2016 goal 11 months early. We continue to advance new models for value-based payments in Medicare and implement bipartisan Medicare physician payment reforms.
- Implementing the funding pool created by the ACA for Community Health Centers to build, expand and operate health-care facilities in underserved communities. Since the beginning of 2009, thanks to this and other investments, health centers have increased the number of patients served by 6 million.
- Expanding health provider training opportunities, with an emphasis on primary care, including a significant expansion of the National Health Service Corps. As of September 30, 2015, there were 9,600 Corps clinicians providing primary care services, over twice the number of clinicians in 2008 (3,600).
 Updated national health expenditure projections published this summer estimated that the United States would spend a total of $31.8 trillion on health care over the 2010-2019 period. The final national health expenditure projections published prior to the ACA’s enactment, adjusted slightly to reflect then-current policy according to the methodology applied in a recent Urban Institute study, estimated that spending would total $34.4 trillion over that period. The difference between these two projections is $2.6 trillion.