President Barack Obama has published a review in JAMA of what the Affordable Care Act (ACA) has and has not accomplished since its passage in 2010. Here are the highlights:
- The ACA has been successful in sharply increasing insurance coverage. Since the ACA became law, the uninsured rate has declined from 16% in 2010 to 9.1% in 2015, a relative decrease of 43%.
- States that decided to expand their Medicaid programs saw larger reductions in their uninsured rates from 2013 to 2015, especially in states that started with large uninsured populations.
- Early evidence suggests that expanded coverage has led to modest improvements in some measures of access to treatment, financial security, and health.
- Payer spending per health care enrollee has continued to decline in a continuation of pre-2010 trends, and health care quality has improved.
The president reflects on work yet to be done and lessons learned. He calls on Congress to “avoid moving backward on health reform,” calling out Republicans for reversing course and rejecting their own ideas once they appeared in the context of the bill he supported. “We need to continue to tackle special interest dollars in politics,” he writes, noting stakeholders who sought to obstruct reform to favor profits over the public good. And he emphasizes the need to prioritize pragmatism over ideology in crafting and implementing legislation.
Read the president’s paper in full for yourself, as well as accompanying editorial responses by Stuart Butler, Peter Orszag, Jonathan Skinner and Amitabh Chandra, and JAMA Editor in Chief Howard Bauchner, MD.