Sylvia Burwell, new analysis make case for ACA optimism

Document titled "Patient Protection and Affordable Care Act"

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Despite signs of trouble for the Affordable Care Act marketplaces, some point to the progress the healthcare reform law has made--and the potential for more improvement--as reasons to be optimistic.

A new report, for example, highlights the fact that in the first full year of ACA implementation, the number of uninsured adults dropped by more than 8 million. Otherwise expressed, the share of non-elderly uninsured adults declined from 21 percent in 2013 to 16.5 percent in 2014. Since then, the uninsured rate has dipped to an all time low of 8.6 percent.

The report, from the Urban Institute and the Robert Wood Johnson Foundation, says the dramatic decline in the uninsured rate in 2014 can be traced to factors including enrollment in the new ACA marketplaces, private health insurance coverage changes, effects of the individual coverage mandate and new Medicaid enrollment.

States with the lowest rates of uninsured, childless adults were those that chose to expand Medicaid eligibility, while those that opted against Medicaid expansion had higher rates.

Looking ahead, the report notes that many uninsured parents and childless adults fall into an “assistance gap” in which they qualify for neither Medicaid nor marketplace subsidies. For these individuals, the expansion of Medicaid in their home state is their best chance for access for affordable health insurance, the report concludes.

The Obama administration has also pushed hard for holdout states to embrace Medicaid expansion. In a recent op-ed published by CNN, Health and Humana Services Secretary Sylvia Mathews Burwell cites a government brief that found expanding Medicaid helps reduce marketplace premiums for middle-income families.

Burwell also calls on insurers to “continue to adapt” to the challenges of competing in the individual market. The more successful issuers, she notes, have accomplished this by focusing on care coordination and quality improvement.

Burwell acknowledged 2017 will be a “transition year” for the marketplaces, in part because many insurers must raise premiums make up for initially pricing plans too low. Yet many consumers will be insulated from these increases, she notes, because of the financial assistance options the ACA offers.

Struggles operating in the individual market have also led major insurers such as UnitedHealth, Humana and Aetna to announce they will leave many ACA marketplaces in 2017, sparking renewed worries about the future of the exchanges.

The federal government, though, has responded to insurers’ concerns by proposing policy fixes such as restructuring the way medical loss ratios are calculated and allowing more flexibility in insurance product design.