Checking in on the ACA, Three Years Down the Road


We may be a little late to the dance on this, but it needs to be acknowledged that the Affordable Care Act marked its third anniversary in March…despite 39 (unsuccessful) attempts to have it repealed.

So, three years down the road, the question, with a nod to the late Ed Koch, needs to be asked: “How’m I doin’?” Well, despite Republican leaders in Congress who regularly denounce the ACA, vow to block funding to carry it out or even repeal it, the answer is “not bad.”

Although the date for full implementation of most provisions of the law is January 1, 2014, the ACA has already had an impact on the goals of expanded coverage of the uninsured, improved access and better care delivery models, broader access to community-based long-term care, and more integrated care and financing for beneficiaries who are dually eligible for Medicare and Medicaid. While the ACA remains controversial, with many debates about its future as well as provisions already implemented, implementation is moving ahead.

Beginning in 2010, young adults up to age 26 can remain on their parents’ insurance policies even if they are no longer living with a parent, are not listed as a dependent on a parent’s tax return, or are no longer a student. According to Census data, over two million young adults have gained coverage under this provision, contributing to the decline of 1.3 million in the number of uninsured Americans in 2011.

Additional highlights include:

  • 17 million Americans now receive some kind of free preventive service, such as flu shots, and 34 million Medicare recipients received free preventive services in 2012
  • 17 million children with pre-existing conditions are now protected against being uninsured
  • More than 107,000 adults with pre-existing conditions finally have insurance under the federally run insurance program
  • 21 million received care from expanded community health centers; 3 million more than previously served
  • $1.1 billion in rebates, an average of $151 per family, was paid by insurers that failed to meet the benchmark of 80 to 85 percent of premium revenues on medical claims or quality improvements
  • Since 2010, more than 6.3 million older or disabled people have saved more than $6.3 billion on prescription drugs.

Perhaps most importantly, there are signs that the ACA has already started to help slow the growth of health care costs and improve the quality of care through value-based purchasing programs, strengthened primary care and care coordination, and pioneering Medicare payment reforms. For each year from 2009-2011, National Health Expenditure data show the real rate of annual growth in overall health spending was between 3.0 and 3.1 percent, the lowest rates since reporting began in 1960.

Speaking of primary care, providers get increased Medicare and Medicaid payment rates under the ACA, according to a Kaiser Family Foundation report. The law provides for a 10 percent bonus payment on top of the regular Medicare fee schedule amount for many services provided by primary care physicians (and other practitioners) from 2011 through 2015. The law also requires states to raise their Medicaid payment rates in 2013 and 2014 to Medicare payment levels for many primary care physician services. As a result, Medicaid primary care fees will increase by 73 percent, on average, in 2013 although the size of the increase will vary by state.

As a recent editorialin The New York Times noted, one of the most promising aspects of the ACA is its focus on improving quality. According to the editorial, the percentage of Medicare patients requiring readmission to the hospital within 30 days of discharge dropped from an average of 19 percent over the past five years to 17.8 percent in the last half of 2012, an improvement due in large part to penalties imposed by Medicare to providers to encourage better coordination of care after a patient leaves the hospital.

It’s also worth noting that, as we here at JSPH have, the ACA supports population-based prevention activities through a new Prevention and Public Health Fund. This Fund has been used to make over $1 billion in critical investments in programs aimed at reducing the burden of chronic disease an improving overall health of communities. Funding has supported Community Transformation Grants in 36 states to reduce the incidence of heart attacks, strokes, cancer, and other diseases; rebuilding the immunization infrastructure, tobacco cessation programs; and substance abuse and suicide prevention activities.

Happy(belated) Birthday, ACA. This School of Population Health feels you’re on the right track, and we feel we are, too.

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