Five Years Later: Building on the Successes of the Affordable Care Act

March 23, 2015

Today, the Affordable Care Act turned five. That is something to celebrate.

In California, over 4.4 million individuals gained coverage under and the new Medi-Cal expansion, cutting the uninsured rate in half. Premiums have only risen at a slow rate, despite predictions that they would spiral out of control. Subscribers are satisfied with their coverage and are re-enrolling.

Californians are positive about the ACA.

The good news is not just limited to California: In 2010, the ACA was predicted to reduce the deficit by $143 billion. It is now predicted to lower the deficit by $152 billion in the next 9 years. 16 million Americans currently receive care through the ACA, and that number is expected to rise to 25 million in 4 years. The uninsured rate in America is now down to 12.9%, and is expected to continue to drop. The Department of Health and Human Services reported that hospitals have seen a $7.4 billion decline in uncompensated care costs among Medicaid expansion (5 billion reduction) and non-expansion states (2.4 billion reduction) following the implementation of the ACA.

In light of these successes, we must look forward to the next couple of years. While the ACA has been hugely successful in its goals, there remain many opportunities to further expand coverage and to improve the quality of care. The Small Business Health Options Program (SHOP) has room to improve the experience for small businesses. The interfaces between the county governments and Covered California must improve in order to ensure continuity of care as individuals move between Medi-Cal, Covered California, and employer-based coverage. And incentives between payors, plans, and providers need to be better aligned to ensure that quality care remains accessible for all Californians in the future.

Looking even further out, more work is necessary to finally guarantee universal coverage, both in California and in the nation as a whole. Neither Covered California nor Medi-Cal provides coverage to the 1.6 million uninsured undocumented immigrants living in California. Meanwhile, the petitioners in the pending King v. Burwell Supereme Court case seek to revoke tax subsidies that provide affordable care to 8.2 million people who live in states that do not operate their own health exchanges, such as Texas or Florida (but not California). If we are to attain universal coverage, policy makers will need to tackle these barriers to expanding care to all Americans, regardless of their state of residence or documentation status.

In conclusion, as we celebrate the successes of the past five years of reform and advancement in healthcare, we must remain diligent, identifying and developing creative new solutions to continued and emerging issues.