- As the 10-year anniversary of the passage of the Affordable Care Act nears, researchers writing in Health Affairs have found the law eased cost barriers to coverage and care and lowered the financial risks of illness. The law pushed down the uninsured rate, improved access to care and "led to measurable gains in the financial well-being of poor Americans," the researchers wrote.
- The ACA's marketplace was a key part of improved financial protection. Among those eligible for cost-sharing reductions, 57% had a deductible of less than $1,000. The share with a high deductible relative to income dropped from about 30% in 2012 to about 25% in 2014 and has remained there through 2018, according to the report.
- However, the courts and the current executive branch have impeded the ACA's full potential. The Supreme Court ruling that made Medicaid expansion optional impeded coverage for millions of low-income Americans. Meanwhile, President Donald Trump's administration has chipped away at market reforms for example by allowing non-compliant ACA plans to expand.
Even after a decade, the landmark health law is under threat as the Supreme Court will once again decide the fate of the law and whether it can stand, agreeing on Monday to take up a Republican-led challenge to the law for the third time.
Overturning the law would cause millions to lose coverage and access to care. Peeling back its provisions would risk returning to a vastly different healthcare landscape.
The researchers said the justices "will need to reckon with a considerable body of evidence showing the far-reaching effects of the ACA on Americans' insurance coverage, access to care, and financial health ten years after the law's historic passage."
In 2008, nearly 56 million Americans had been uninsured for at least part of the prior year, according to the new paper. In 2010, CMS actuaries expected 10 million more Americans to become uninsured by 2019.
As coverage rates were declining, cost-sharing requirements were increasing for those with private coverage.
Prior to the ACA, it was difficult for Americans with pre-existing conditions to obtain coverage outside of work and even when consumers secured coverage it wasn't uncommon for policies to contain lifetime limits.
"Limits on access to and the content of coverage in the pre-ACA period left this group vulnerable to considerable financial risk," according to the report.
The ACA implemented a number of market reforms that changed this dynamic. There are now protections for those with pre-existing conditions and the law requires certain benefits to be covered by insurance.
The law also reshaped the individual market, allowing eligible consumers to purchase subsidized coverage that also provided out-of-pocket spending protection.
"We found that the Affordable Care Act generated substantial, widespread improvements in protecting Americans against the financial risks of illness," according to the report.