The Affordable Care Act open enrollment period opened up again on Nov. 15 and will run through Feb. 15. With the second round of enrollments, things are expected to go a bit more smoothly. Many of the promises made by President Obama have been kept, but the ACA also had its fair share of obstacles. Here's the scoop on one year with Obamacare one year after the launch of healthcare.gov:
The current rate of uninsured adults, 13.4 percent, is the lowest it has been since Gallup began measuring the rate in 2008. The uninsured rate fell most steeply among blacks, Hispanics and lower-income Americans.
It is difficult to demonstrate that the ACA is making the population healthier, since data is still nascent. But early data shows that the ACA is having a positive effect on young people, who, thanks to one of the law's changes, can remain on their parents' healthcare plan until their 26th birthdays. First, the percentage of 19 to 25-year-olds without health insurance dropped from 34 percent in 2010 to 21 percent for the first quarter of this year. Mental health treatment for 18 to 25-year-olds who said they had a mental disorder also increased by 5.3 percentage points compared to the 26 to 35 age group. This marks an improvement as young people experience metal health problems at rates higher than other age groups. And college students also are more likely to report excellent health, having a primary doctor and going to the doctor more regularly.
Millions of new customers will use the exchange this fall, and many of the 7.3 million who bought health insurance last year will return to update their accounts or shop for better deals. The Congressional Budget Office estimates that as many as 13 million will enroll by 2015.
The online exchanges have only been open for a year, so it is difficult to measure the law’s impact. Still, healthcare companies have witnessed substantial profits so far this year. The law has allowed more people to go to hospitals and increased the number of prescription drug users, bolstering the pharmaceutical industry.
“Healthcare is a tricky sector to evaluate in terms of its contribution to overall productivity, said Thomas Ogorzalek, a Northwestern political science professor. "A healthy workforce is certainly a good investment, so emphasis on preventative care should boost the national performance. Some firms have chafed under the law's requirements, while others have hailed the flexibility it affords the workforce generally, because large employers are no longer the only source of affordable health insurance for workers.”
The Department of Health and Human Services released estimates showing that hospitals will save $5.7 billion in uncompensated care costs this year because more people are now covered. It is unclear if such benefits will continue, but for now, the healthcare industry doesn’t seem to be suffering as some had predicted it would once the ACA was implemented.
The biggest challenge to accomplishing the goals of the ACA has been the refusal by some states to expand Medicaid eligibility to the standards set by the ACA. States that expanded Medicaid also saw a substantial drop in uninsured residents. The Supreme Court ruled in 2012, though, that the expansion was the states' choice. 23 states, most of them Republican-controlled, refused Medicaid expansion.
“Healthcare represents a massive share of our national economy, and areas of regulation like this are probably best integrated at the national level, to avoid the hodgepodge of regulations and inequality of treatment among Americans that would likely arise under a state-by-state system,” Ogorzalek said. “We're already seeing this under the states that are resisting implementation.”
One of the promises President Obama made concerning the ACA was that it would decrease healthcare spending. There has been a decrease in spending since the law was implemented, but healthcare spending had been slowing down before the law took effect. It is hard to know what the effects of the ACA are or will be, but estimates show that it could drive up costs as the ACA brings in more people into the system. Prices for the same plans can vary across states, and even within them, as insurers pursue different strategies to cover all their costs.
“The odds are that it is not going to reduce healthcare spending itself,” said Burton Weisbrod, a Northwestern economics professor. He noted that that all the money used to provide more coverage and services is very unlikely to be offset completely by savings in other aspects of the law.
The law continues to be a source of great conflict and criticism. With over 50 attempts to repeal the law, the Republican-controlled House of Representatives has made it clear that it does not support the ACA.
“The political environment surrounding the law remains toxic, as Republicans continue to seek to undermine its implementation. Upcoming court cases could dramatically weaken the law in states with governors who do not want to cooperate with DHHS on its implementation,” Ogorzalek said.
The ACA faces another round in the Supreme Court, this time to re-examine the constitutionality of its subsidies. The Court will revisit King v. Burwell, in which the Fourth Circuit upheld the IRS’s rule that allows the distribution of health insurance subsidies to states operating under the federal insurance marketplace.
If the Supreme Court rules against the subsidies, lower-income people in a handful of states could lose the subsidies that make healthcare available to them.
“Anytime you make a major transition, there are going to be problems," Weisbrod said. "Sometimes the problem could have been avoided if things are done better, which is certainly the case here. In a couple of years or so I think we’ll look back at this and have a different take on it.”