Under the Obama administration, the country has made “historic progress” toward the goals of expanding insurance coverage and improving the delivery system, according to a new report from the White House Council of Economic Advisers.
The report (PDF), which quantifies some of the trends tied to the Affordable Care Act and other regulatory changes under President Barack Obama, comes as his signature domestic achievement is facing perhaps its biggest threat once Republicans gain control of both the White House and Congress.
Though the report doesn’t explicitly mention the possibility of an ACA repeal, it does say that the executive branch, Congress and state and local governments must all do their part to ensure progress continues. “Whether and how policymakers rise to that challenge will have profound implications for the healthcare system and, by extension, Americans’ health and economic well-being in the years to come,” it says.
Here are some of the measures of healthcare reform progress the report highlights:
Coverage expansion and its effects
- In 2008, the year before Obama began his first term, more than 1 in 7 Americans, or 44 million people, lacked health insurance coverage. As a result of the ACA’s coverage expansions, an estimated 20 million people have since gained insurance.
- If the experience under the ACA matches what was observed under health reform in Massachusetts, the report estimates that 24,000 deaths are already being avoided each year because of health improvements tied to expanded coverage.
Improved health and patient care
- The rate at which patients are harmed while seeking hospital care has fallen by 21% since 2010, leading to about 125,00 avoided deaths through 2015.
- From April 2010 to May 2015, there were an estimated 565,000 avoided hospital readmissions among Medicare beneficiaries.
Reduced costs for payers, providers
- From 2013 to 2015, uncompensated care has fallen by more than a quarter as a share of hospital operating costs, corresponding to a reduction of $10.4 billion.
- Estimates from the Congressional Budget Office imply that the ACA reduced the growth rate of per-beneficiary Medicare spending by 1.3 percentage points annually from 2010 through 2016.
- Over the same period, spillover effects of the law’s Medicare reforms have likely subtracted between 0.6 and 0.9 percentage points a year from the growth rate of per-enrollee private insurance spending.
Delivery system reform
- About 30% of traditional Medicare payments were associated with advanced-payment models as of early 2016.
- That shift has also influenced private payers: About 17 million private insurance enrollees are estimated to be covered under similar accountable care payment arrangements, compared to “virtually none” as recently as 2011.