It has been almost six years since The Patient Protection and Affordable Care Act, also known as the Affordable Care Act (ACA) was passed in 2010 and while there has been criticism from day one about both the concept of “free” health care as well as the way it was implemented, this piece of legislation is doing what it was intended to do; provide “quality, affordable health care for all Americans.” On Monday, July 11, 2016, President Barak Obama’s paper titled United States Health Care Reform: Progress to Date and Next Steps was published in The Journal of the American Medical Association (JAMA). In it, he details the measurable successes of the ACA over the last six years and provides guidance for the continued improvement of quality and cost of health care coverage for U.S. citizens.
Universal health care was implemented under the assumption that citizens have the right and not the privilege to be and stay healthy. The United States has, until 2010, operated its health care system based on socioeconomic privilege, whereby, if you have a good job or enough money, you have the privilege to maintain your health. At the same time, anyone whose job does not provide health coverage or who cannot afford to pay out of pocket hasn’t earned the same privilege to a healthy life.
On the most basic level, ACA has achieved its goal: to provide health care to everyone. Between the 1980 and 2010, the percent of uninsured Americans increased from 11 percent to 16 percent. Within three years of the ACA taking effect, the percentage of U.S. citizens without insurance dropped to 9.1 percent after rising for the previous thirty years- a decline of 43 percent.
The quality of health care has improved since the ACA took effect. Hospital acquired conditions (Embolisms, foreign object left in the body, or urinary tract infections from catheters) declined by 17 percent between 2010 and 2014, preventing an estimated 87,000 deaths over that short period of time. The ACA also includes a Readmissions Reduction Program (HRRP) to further ensure the quality of care. Beginning in 2012, the Centers for Medicare and Medicaid Services (CMS) imposed a penalty up to 3 percent of the Medicare payments to the hospital for patients readmitted to the hospital within 30 days of discharge. There is a direct correlation between high readmission within 30 days and hospital acquired conditions as a result of inferior care. However, the implementation of the ACA, the number of patients readmitted within 30 days declined from 19 percent to 17.8 percent, suggesting better care is provided when threatened with a cut in funding.
The affordability of health care was also a goal of the ACA as socioeconomic challenges had prevented many Americans from receiving consistent care for both chronic and acute ailments. Now, the ACA is decreasing costs to citizens and those costs continue to decline. From 2006-2010, the mean growth of health care costs per enrollee in Medicare was 2.4 percent per year. Now, there is a negative increase per year. Private insurance costs are down from a mean growth of 3.4 percent per year from 2005-2010 to just 1.1 percent growth per year in 2015.
While the availability, quality, and affordability of heath care are continually improving, more can be done to improve the system. Americans are now required to have proof of health care coverage or suffer a $325 penalty or 2 percent of your household income above your tax return filing threshold. Many of those who incur the penalty still do not understand that preventative health care can help keep overall costs of heath care down. Even more can be done to educate anyone who has not signed up to do so both from a financial and heath health standpoint. Additionally, “Only 799 out of more than 3,400 hospitals subject to the Hospital Readmissions Reduction Program performed well enough…to face no penalty” in 2016. The final goal should be zero hospitals subject to that penalty; a serious decline in hospital acquired conditions through improve care and hospitals receive their full payment. Finally, we must work on tackling costs that still allow patients to accrue debt, like pharmaceuticals, where “any change to drug pricing, no matter how justifiable and modest, because… it threatens their profits.”. The Affordable Care Act is the first huge step towards making the health of the nation’s people a top priority but there are many more steps ahead that lead the path to quality and affordable health care as a right and not just a privilege.
This article was written by Erin Benton, a writer for dusk magazine.