Special to The Dallas Examiner
Recently, the U.S. Department of Health and Human Services released an extensive compilation of national and state-level data illustrating the substantial improvements in health care for all Americans in the last six years. The uninsured rate has fallen to the lowest level on record, and 20 million Americans have gained coverage thanks to the Affordable Care Act. But beyond those people who would otherwise be uninsured, millions of Americans with employers, Medicaid, Medicare or individual market coverage have benefited from new protections as a result of the law.
“As our nation debates changes to the health care system, it’s important to take stock of the historic progress in recent years,” said HHS Secretary Sylvia M. Burwell. “Whether they get their coverage through an employer, Medicaid, the individual market, or Medicare, Americans have better health coverage and health care today as a result of the ACA. Millions of Americans with all types of coverage have a stake in the future of health reform, and it’s time to build on the progress we’ve made, not move our system backward.”
Highlights of the data release include:
Employer coverage: More than 150 million Americans are covered through employer-sponsored health plans. Since the ACA was enacted, this group has seen:
• An end to annual and lifetime limits: Before the Affordable Care Act, 105 million Americans with employer or individual market coverage had a lifetime limit on their insurance policy. The ACA prohibits annual and lifetime limits on policies, so all Americans with employer plans now have coverage that’s there when they need it.
• Young adults covered until age 26: An estimated 2.3 million young adults have benefited from the ACA provision allowing children to stay on their parents’ health insurance up to age 26.
• Free preventive care: Under the ACA, health plans must cover preventive services – like flu shots, cancer screenings, contraception, and mammograms – at no extra cost to consumers, benefiting about 137 million Americans, most of whom have employer coverage.
• Slower premium growth: Average family premiums for employer coverage grew 5 percent per year from 2010-2016, compared with 8 percent over the previous decade. Family premiums are $3,600 lower today than if growth had matched the pre-ACA decade.
• Better value coverage: Insurers must now spend at least 80 cents of premium dollars on health care, rather than administrative costs, or else give consumers a refund. Americans with employer coverage have received more than $1 billion in insurance refunds to date.
Medicaid: More than 70 million Americans have coverage through Medicaid or the Children’s Health Insurance Program, including millions of children, seniors and people with disabilities. Under the ACA, Medicaid provides:
• More coverage: Thanks in large part to Medicaid expansion, 15.7 million more people have Medicaid coverage today than before the ACA’s major coverage provisions took effect.
• Better health and financial security: Medicaid expansion has resulted in more than 500,000 people getting all needed care, over 625,000 fewer people struggling to pay bills, and more than 5,000 fewer avoidable deaths each year.
• Better addiction and behavioral health coverage: The ACA is helping states improve care for people struggling with opioid or other addictions or mental illness. Nearly 30 percent of those who could gain coverage if more states expanded have a mental illness or substance use disorder.
• Less uncompensated care: Hospital uncompensated care costs fell by an estimated $7.4 billion after the ACA’s major coverage provisions took effect. Expansion states account for $5 billion of that reduction, while states choosing not to expand are leaving an estimated $4 billion in savings on the table.
Individual market: More than 10 million people have coverage through the Marketplace. Individual market coverage is dramatically better compared to before the ACA:
• No discrimination based on pre-existing conditions: Up to 129 million Americans have a pre-existing health condition. Before the ACA, this group could have been denied coverage or charged an exorbitant price if they needed individual market insurance. Now, health insurance companies cannot discriminate against people based on of their medical history.
• Tax credits to help pay for coverage: Before the ACA, only those with employer coverage generally got tax benefits to help pay for health insurance. Now, about more than 9 million moderate- and middle-income Americans receive tax credits averaging $300 per month to help them get covered.
• Women pay the same as men: Before the ACA, women were often charged more for health insurance than men just because of their gender. Thanks to the ACA, that is now illegal, protecting roughly half of all Americans.
• Greater transparency and choice: Before the ACA, consumers struggled to compare individual market plans and prices. Thanks to the ACA, they can now shop for coverage on a transparent market, choosing among an average of 30 plans on http://www.healthcare.gov.
Medicare: 55 Million Americans have coverage through Medicare. The ACA strengthened the Medicare Trust Fund, extending its life by over a decade. In addition, Medicare enrollees have benefited from:
• Lower costs for prescription drugs: Because the ACA is closing the prescription drug donut hole, more than 11 million Medicare beneficiaries saved more than $23 billion total, an average of more than $2,000 per beneficiary.
• Free preventive services: The ACA added coverage of an annual wellness visit and eliminated cost-sharing for recommended preventive services such as cancer screenings. In 2015, 26 million seniors, or 73 percent of all seniors enrolled in Medicare Part B, took advantage of at least one free preventive service.
• Fewer hospital mistakes: The ACA introduced new incentives for hospitals to avoid preventable patient harms and avoidable readmissions. Hospital readmissions for Medicare beneficiaries dropped 8 percent, which translates into 565,000 times Medicare beneficiaries have avoided an unnecessary return to the hospital since 2010.
• More coordinated care: The ACA encouraged groups of doctors, hospitals, and other health care providers to come together to provide coordinated high-quality care to the Medicare patients they serve. Accountable Care Organizations now offer 8.9 million Medicare beneficiaries higher quality, more coordinated care.