Ten Hits and Misses after 5 Years of the Affordable Care Act

Since its enactment in 2010, the Affordable Care Act has come a long way in pursuit of its primary goal of a fully insured America. When the ACA was rolled out, it aimed to provide affordable health insurance to 32 million people by 2019. To realize that goal, the administration worked on a variety of initiatives, such as the setup of state and federal marketplaces that helped customers to shop for health insurance in a consumer centric marketplace format. The expansion of Medicaid was proposed to assist the momentum built by the ACA, and the health insurance industry was realigned to cut costs and suit the workings of the law.

In the last 5 years, ACA has had some hits and some misses in its journey. Today, we take a look at the top ten hits and misses in its 5-year journey.

1)  The Obama administration established the federally facilitated marketplace (aka healthcare.gov) that helped states without their own exchange offer subsidized health insurance to their citizens. For states that established their own state exchange, the Obama administration offered monetary support through grants that helped states pay for the exchanges. Although these exchanges struggled in the first 3 months, they delivered a solid enrollment figures when the first open enrollment ended in March 2014.

2)  As per the first enrollment, the administration was able to enroll 8 million even after suffering major setbacks in the first three months of enrollment. The majority of these enrollments were done over the phone or by paper apps.

3)  As many as 87 percent of the enrollees were able to control their health insurance costs through the exchange provided subsidies. These subsidies worked to minimize the cost of health insurance for people up to 400 percent of the federal poverty level, thus helping families cover for their health insurance. With removing the pre-existing condition, the ACA opened doors to people who had trouble finding insurance.

4)  By the end of the second open enrollment period in February 2015, the Obama administration managed to enroll 11 million people through the exchanges. Although a large chunk of these enrollments were people who had enrolled last year, deeper penetration of the law in the market was prevalent.

5)  It is expected that about 85 percent of the new enrollees will be eligible for the health insurance subsidies. Owing to the subsidies and the interest of healthy individuals in the law, the premium rise in the year 2015 was marginal.

6)  However, it seems that there will still be around 30 million uninsured Americans by 2019. If healthy individuals start dropping their health insurance, this number might go up, thus destabilizing the market and opening it for more challenges in terms of insurance pool balance.

7)  The ACA was built with concept of parallel expansion on Medicaid to cover some sections of the public. Since some states chose to not expand Medicaid, about 5 million people are stuck in a coverage gap, which prevents them from getting subsidies to cover their insurance costs from the exchanges nor are they eligible for Medicaid.

8)  Although health insurers are working with the law to provide affordable coverage, they have resorted to alternate measures to keep their profit margins. A lot of health plans have narrowed their networks and connected with low cost hospitals and physicians.

9)  Due to subsidies is such that people are choosing mid-tier silver plans, which ultimately cost a little higher but offer better cost assistance to consumers. However, the Silver plans expose the consumers to 30 percent of their healthcare costs, while 70 percent is covered by their plan, but most of these people cannot afford that remaining cost, and ultimately risk dropping their coverage and incurring significant medical debt.

10)  The shortage of primary care physicians is another challenge. The country is short of about 45,000 physicians, and most of the existing ones are no longer accepting new patients.

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