ACA Progress Report – A Good News, Bad News Story

In the July 17 New England Journal of Medicine, David Blumenthal MD, and Sara Collins, PhD, sum up the progress of the ACA through March 31, 2014. It was the last chance to enroll through the individual marketplaces until the next open enrollment period in November, which will occur shortly after the midterm elections. (" Health Care Coverage under the Affordable Care Act," NEJM, July 17, 2014).


The summary of the 3657 word report contains the following
three conclusions.

• One, Taking all existing coverage expansions together, an estimated 20 million Americans gained coverage: 1 million young adults (19 to 26 years of age under their parent’s policy), 8.0 million consumers who selected a marketplace plan, 5.0 million consumers who purchased directly from insurer, 6.0 million consumers who enrolled in Medicaid or Children’s Health Insurance Program (CHIP)

• Second, experience with the ACA varies enormously among states. Those deciding not to expand Medicaid benefited less from the law, and since many of these states have high rates of uninsured residents and lower health status. The ACA may have the paradoxical effect of increasing disparities across regions, even as it reduces disparities between previously insured and uninsured Americans as a whole.

• Third, the sustainability of the coverage expansions depends to a great extent on the ability to control the overall costs of care in the United States. Otherwise, premiums will become increasingly unaffordable for consumers, employers, and the federal government. Insurers who seek to control those costs through increasingly narrow provider networks across all U.S. insurance markets may ultimately leave Americans less satisfied with their health care. Developing and spreading innovative approaches to health care delivery that provide greater quality at lower cost is the next great challenge facing the nation.

This is clearly a good news (20 million more insured ), bad news story (premiums may become unaffordable for consumers, employers, and government, networks of doctors are narrowing, and some Medicaid recipients are being left out in the cold).

Read the report in full. You can get it on Google. It has thoughtful sections on major coverage expansion, individual marketplaces, enrollment outside ACA marketplaces, cancelled policies, risk pools and 2015 premiums, narrow networks, Medicaid and Children’s Health Insurance Programs, reforms of small businesses, and record to date.