The ACA 12 Years Later

If only we were warned!

The ACA (“Obamacare”) 12 years later. Net result? Dramatically higher premiums for those who do not qualify for subsidies and large out-of-pocket costs for those that do. If only someone told us about this way back then. – C. Steven Tucker

HealthAffairs-

Getting healthcare right has been one of the largest challenges for the U.S. Now, 12 years after President Obama signed the Affordable Care Act (ACA) into law, an estimated 24 million more Americans have gained health coverage. But was the ACA as transformative as it could have been?

A white paper published Feb. 2022 by FAIR Health reported on data from two national surveys revealing “one in four adults aged 65 and older skip care due to high costs” and 25% of that same demographic “never” know the cost of healthcare services prior to receiving a bill. The surveys’ findings also highlight the need for shared decision-making tools and resources.

There is no question that passing of the ACA law allowed individuals to receive first time health coverage at a low cost, but health care is now unaffordable for many middle-class people and families who don’t qualify for federal subsidies or Medicaid. The Kaiser Family Foundation reported “the average premium for a mid-level plan for a 40-year-old who doesn’t qualify for a subsidy climbed to $462 a month in 2020 from $273 in 2014.” And the law has done little to address soaring prescription drug costs and high deductibles.

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Unlike most industries where supply drives down prices, healthcare supply creates its own demand. The more available doctors, the more visits to see these doctors; the greater the patient monitoring, the higher the use of therapeutic procedures. However, such increases often show no statistical change in outcomes. This results in the anomaly of wide geographic variation in treatment patterns. This problem remains the direct result of a system that delegates health decision-making to doctors who do not always use evidence-based models or a shared decision-making approach that includes patients in the middle of the care process.