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May 2014 St@teside

Progress Under the Affordable Care Act

Much of the focus over the past few months has been on enrollment numbers in the health insurance marketplaces and Medicaid. However, the impact of the Affordable Care Act (ACA) is starting to be seen throughout the U.S. health care system. According to the most recent Gallup poll, the rate of uninsured dropped from 15 percent in March to 13.4 percent in April, which is the lowest recorded rate of uninsured to date. While the rates in uninsured are disproportionate across some demographic groups (e.g., Hispanic Americans have an uninsured rate of 33 percent, whereas White Americans have an uninsured rate of 9 percent), the rate of uninsured decreased across nearly all of these groups.

With more people insured, longstanding concerns have been raised about how this pent-up demand for health care services would impact wait times to see providers. However, with 13 million insured under the ACA during the first open enrollment, Kaiser Health News recently reported that the primary care system has been able to absorb the surge in insured without seeing delays in care. Nonetheless, as coverage for some latecomers to the marketplace won’t begin until June and new Medicaid enrollees may not yet have received their Medicaid card, primary care providers continue to brace for greater demand.

Additional impacts of the ACA have been seen through the regulation of medical loss ratios (MLRs). Under the MLR provisions of the ACA, insurers are required to spend 80 percent of premiums in small-group and individual markets and 85 percent of premiums in the large-group market actual medical care and quality improvement activities, as opposed to having those funds go towards profits, administrative costs, and sales expenses. Insurers with MLRs that fall below these percentages must pay out the difference to consumers through rebates. According to this Commonwealth Fund report, in the first two years of the implementation of these MLR regulations, insurers paid out $1.5 billion in consumer rebates and reduced overhead spending by $1.75 billion.

Following on the trail of these recent ACA developments, the Annals of Internal Medicine published a study examining how Massachusetts’ 2006 health care reform initiative, which served as a model for the ACA, impacted population health. This study, conducted by the Harvard School of Public Health, found that in the four years following the implementation of health reform, the mortality rate in Massachusetts fell by 3 percent. The generalizability of these results and the causal relationship between Massachusetts’ reform and decline in mortality have been much debated, such as here and here; however, this study highlights the potential of health care reform to not only impact access and coverage, but also the health and well-being of the U.S. population.