In this Special Communication, I assess the progress the ACA has made toward improving the US health care system and discuss how policy makers can build on that progress in the years ahead. However, the work toward a high-quality, affordable, accessible health care system is not over. Americans can now count on access to health coverage throughout their lives, and the federal government has an array of tools to bring the rise of health care costs under control.
The result of that effort, the Affordable Care Act (ACA), has made substantial progress in addressing these challenges. Regardless of the political difficulties, I concluded comprehensive reform was necessary. When I took office, health care costs had risen rapidly for decades, and tens of millions of Americans were uninsured. Health insurance enables children to excel at school, adults to work more productively, and Americans of all ages to live longer, healthier lives. Health care costs affect the economy, the federal budget, and virtually every American family’s financial well-being. Despite this progress, major opportunities to improve the health care system remain. These and related reforms have contributed to a sustained period of slow growth in per-enrollee health care spending and improvements in health care quality. The law has also begun the process of transforming health care payment systems, with an estimated 30% of traditional Medicare payments now flowing through alternative payment models like bundled payments or accountable care organizations. Research has documented accompanying improvements in access to care (for example, an estimated reduction in the share of nonelderly adults unable to afford care of 5.5 percentage points), financial security (for example, an estimated reduction in debts sent to collection of $600–$1000 per person gaining Medicaid coverage), and health (for example, an estimated reduction in the share of nonelderly adults reporting fair or poor health of 3.4 percentage points).
Since the Affordable Care Act became law, the uninsured rate has declined by 43%, from 16.0% in 2010 to 9.1% in 2015, primarily because of the law’s reforms. The Affordable Care Act has made significant progress toward solving long-standing challenges facing the US health care system related to access, affordability, and quality of care.
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