The United States Government has played a role in our nation’s healthcare since 1965, with the passing of Medicare and Medicaid. In 2010, the role grew even more expansive when the Patient Protection and Affordable Care Act (ACA) was signed into law. The clear intent of the ACA was to reduce the number of uninsured Americans and control the escalating costs of healthcare services. Since the major ACA provisions went into effect in January 2014, the numbers of non-elderly Americans without healthcare coverage were reduced by nearly 9 million. Unfortunately, there are still an estimated 32 million Americans without healthcare coverage, the majority being from low-income working families. Many remaining uninsured cite one of the reasons for this is the prohibitive cost of purchasing health care. While the ACA has resulted in fewer Americans living without health care coverage, there is much work to be done about increasing affordability and educating those who remain unaware of potential funding assistance.
An important factor to consider regarding the escalating costs of health care is the increasing number of Americans age 65 and older. Currently, persons over age 65 represent a little more than 14% of the U.S. population. That number is expected to reach 22% over the next two decades. As our population ages, their need for medical services increases accordingly making the cost containment provisions of the ACA even more critical.
Since the implementation of the ACA, the per capita cost of health care has steadily remained at or under 3%, however, this lower rate actually began before the law was enacted. According to the Centers for Medicare & Medicaid Services (CMS), the economic slowdown and sluggish recovery has played as much of a role in impacting health care costs as the ACA. While the overall costs of health care have remained steady, the same cannot be said for consumers out of pocket costs, including premiums and deductibles. From 2013 to 2014, while the percentage increase in premium costs increased at lower rates, the average rate of increase is still significant. Overall, premium costs for insured Americans age 23 to 63 increased almost 187% compared to 260% the prior year.
In addition to cost-containment goals, the ACA was designed to drive the focus of healthcare from quantity to quality. In the past, providers were incentivized based on the number of services they provided rather than the quality of the results of care. The health care law contains provisions for the creation of Accountable Care Organizations (ACOs), in effect, incentivizing providers to work together by providing coordinated care for their patients. Early results are showing combined savings of $417 million for Medicare. Other quality metrics are demonstrating that the ACA is having a positive impact on patient care and outcomes. Since 2011, there has been a 17 percent decrease in hospital-related patient harms. Also, Medicare 30-day readmission rates fell 17.5 percent between January 2012 and December 2013.
In the coming years, more data will be available to measure the impact and effectiveness of the health care law. While early results show improvement in some areas, such as the reduction in the numbers of uninsured, there have also been unintended consequences including rising out-of-pocket costs, higher taxes and increasing regulations. One thing is certain, the Affordable care Act is not going anywhere. Lawmakers in Washington will continue tinkering with the legislation for years to come. Throughout, we can remain hopeful that the positive aspects of the legislation can be enhanced while reducing some of the negative consequences of this massive undertaking.
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