Policymakers who advocate for repealing the Affordable Care Act (ACA) have called the health care law a "disaster" and a failed policy. With the failure of the Republican-proposed American Health Care Act, it appears that the ACA is here to stay, at least for the foreseeable future.
The question is: what comes next for the ACA? Now is a good time to revisit the rhetoric around the ACA and consider a path going forward to build on its successes and address its limitations.
As policymakers consider future directions for the ACA, it is important that facts guide the conversations. One important issue to consider is the question of how the ACA has affected access to care. Many who say the ACA has failed say that consumers, including those with Medicaid coverage, have had difficulty finding doctors to treat them under ACA plans.
Are these claims true?
In Michigan, my Center's survey research provides a clear answer: No, consumers are not experiencing more difficulty today accessing health care than before the ACA's coverage expansions were implemented. In fact, for many residents of Michigan, access to care has improved under the ACA.
Tracking Access to Care in Michigan
Since 2009, my Center has tracked access to health care and health status issues in Michigan. Our picture of what has changed for people in Michigan over that time provide federal policymakers with fundamental insights for ensuring that the ACA replacement bill is designed to improve, not harm, access to care.
By almost every measure we have studied, on an overall basis, the ACA has improved the lives of the citizens in our state. Since the ACA's coverage expansions were implemented in 2014, consumers' reported access to care, cost concerns, and coverage satisfaction improved. And, contrary to some national rhetoric, those with Medicaid coverage experienced positive changes, as did those with individually purchased health insurance coverage.
In 2009, almost one in five Michiganders told us that they did not seek care that they needed. And, at 58 percent, the cost of care was the most frequently cited reason for not seeking needed services. By 2015, the proportion of those not seeking needed care had not significantly changed, though cost was no longer the most cited reason for forgoing care. Only 37 percent of surveyed Michigan adults cited the cost of care as their reason for not getting the care they needed, a significant improvement from 2009. Most importantly, our respondents reported a significant decline in medical debt. In 2015, only 19 percent reported difficulty paying medical bills, compared to 27 percent in 2012.
Before the ACA's coverage expansions, policymakers worried that that there would not be enough physicians to care for these newly insured patients, especially those with Medicaid coverage. Our survey data found the opposite: virtually no diminishment in access to care.
Respondents in 2015 told us that it was not hard to get appointments with primary care practitioners: only 12 percent reported difficulty in this regard, the same percentage as in our 2010 survey. Not only did access to primary care not decline under the ACA, Medicaid recipients in our survey saw significantly improved access between 2010 and 2015. In 2010, 25 percent of Medicaid patients reported having a hard time getting an appointment with a primary care physician, compared to only 14 percent in 2015. This improvement in access to primary care for Medicaid recipients occurred at the same time that the number of people covered by Medicaid increased from 1.95 million in March 2014 (19 percent of Michigan's population) to 2.4 million in December 2016 (24 percent of the state's population) as a result of Michigan's Medicaid expansion (called the Healthy Michigan Plan).
Satisfaction with Insurance Coverage in Michigan
Overall satisfaction with coverage also improved in Michigan compared to pre-ACA days. In 2012, 51 percent of Michiganders with all insurance types were satisfied with their health insurance coverage. By 2015, satisfaction has risen to 57 percent.
One of the biggest canards about the ACA is that it has damaged the individual health insurance market. The individual health insurance markets were in terrible shape prior to the ACA, with generally higher premiums and fewer choices for consumers than the employer market. In Michigan, those who expressed the most dissatisfaction with their insurance coverage before the ACA went into effect were those who purchased their coverage on the individual market. In 2012, 45 percent of those who purchased coverage themselves were dissatisfied. By 2015, reported dissatisfaction had dropped to 17 percent.
While there continues to be problems in the individual market and communities where the ACA hasn't yet improved marketplace choice or lowered cost, for the most part, those who purchase individual coverage today have many more choices in the marketplace than they did in 2012.
Consumer trends in Michigan show increased satisfaction, improved access, and reduced medical debt burdens with health insurance coverage since the ACA's implementation. In 2015, 57 percent of adults in Michigan reported having at least one chronic condition and those proportions are even higher for people with individual or Medicaid coverage. These are the individuals most vulnerable to being hurt by changes to the ACA.
The ACA has not fixed America's fragmented and often costly health care system, but that does not mean that consumers, particularly those with individually purchased coverage and Medicaid, are not better off today than they were before. Addressing the underlying cost of health care in America to help reduce premiums, copays, and deductibles is now more important than continuing to repeat that the ACA has failed millions of Americans.
from Health Affairs BlogHealth Affairs Blog http://ift.tt/2mW4bBe
