Studies show Obamacare has been very effective

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Obamacare Has Been Incredibly Effective, According To These Studies

BY LAUREL RAYMOND

APR 26, 2016 1:41 PM

Six years after passing through the House and Senate without receiving a single Republican vote, the Affordable Care Act (popularly known as Obamacare) remains a hotly contested piece of legislation. But outside of the political arena, there’s much less debate.

A mountain of evidence confirms the law’s effectiveness — particularly in its primary goal of expanding health care coverage to some of America’s neediest populations. Several recent studies have confirmed that Obamacare is positively affecting Americans, particularly those who previously couldn’t obtain health insurance or who struggled to pay their medical bills.

Here’s how Obamacare is making a real difference in Americans’ lives:

America’s most vulnerable now have health insurance

In the years since Obamacare passed, many of the largest gains in coverage rates have been in communities that have previously faced barriers to health care access — such as low-wage workers, immigrants, people of color, and people with pre-existing medical conditions.

Between 2013 and 2014, when the law went into full effect, every minority group saw large gains in coverage. According to an analysis by the New York Times. Now, 7.2 more Hispanics, 6.1 percent more Native Americans, 5.1 percent more blacks and 5.4 percent more Asians have health insurance.

Legal immigrants and naturalized citizens also saw large increases in coverage, as did groups that are more likely to be working low-wage jobs, such as high-school graduates and Americans living in non-traditional households, which can be a sign of economic distress.

Indeed, the law was so successful in lifting up undeserved populations that it stopped a decades-long expansion of the health-insurance gap between low-income and wealthier Americans.

And the people gaining coverage under the Affordable Care Act are among America’s sickest, according to a different report from Blue Cross and Blue Shield that analyzed the claims for 4.7 million Americans newly enrolled in insurance plans. New policy holders are more likely to have significant health problems, such as diabetes or HIV, which previously would have locked them out of coverage that they desperately needed.

“It’s no surprise that people who newly gained access to coverage under the Affordable Care Act needed health care. That’s why they were locked out of coverage before,” said Ben Wakana, a spokesman for the Department of Health and Human Services.

People with new health insurance are better off

According to a report from the Urban Institute’s Health Policy Center, Americans who have new health insurance through Obamacare — either through its state-level insurance marketplaces or through its expansion of Medicaid — are better off than the uninsured and in many areas comparable to those with employer-sponsored insurance plans.

Low and moderate-income Americans with marketplace and Medicaid coverage are more likely than the uninsured to have a source of medical care and to have had a checkup in the past year. They are also less likely than the uninsured to report unmet health needs, such as visits to specialists they haven’t been able to make it to.

The research also found that in most cases, marketplace plans were comparable to the employer-sponsored plans that existed before health reform. People insured through Obamacare didn’t struggle more to find new doctors or get timely appointments compared to people insured through their employers. Those with Obamacare’s marketplace plans were also no more likely to report problems paying medical bills or having high out-of-pocket expenses, and were just as satisfied with their premiums.

Those with employer plans were, however, more likely to be satisfied with their choice of providers and their protection against high deductibles, likely because employer plans usually resemble the highest level of marketplace plan.

And while those with Medicaid did report more difficulty getting doctors appointments than those with other types of plans, all groups with insurance were significantly better off than the uninsured — and were likely to have both regular care and lower levels of unmet need due to costs.

Poor Americans are more financially secure

The law has also helped people pay down their bills and slash the amount of debt they carry, according to another paper from the National Bureau of Economic Research.

Americans who signed up for the Medicaid program under Obamacare’s expansion reduced their collection balances by $600 to $1000, according to the researchers. The report also shows that the people who benefited from Medicaid expansion then used that extra money to pay down other debts.

“Health insurance, like any type of insurance, is first and foremost a form of financial protection,” economist Robert Kaestner, one of the study’s authors, toldThe Washington Post. “It is a real benefit.”

According to federal data, medical bills count for more than half of Americans’ unpaid bills, which can drag down people’s credit scores and in the long run, cost them both money and opportunity. Reducing debt can thus have a ripple effect on financial well-being for years into the future.

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Of course, the effect of health reform varies widely across the country. The most marked improvements are evident in states that fully implemented Obamacare, including its expansion of Medicaid to cover more low-income people.

Nineteen states opted not to expand their Medicaid programs — even though the majority of the cost would be covered by the federal government — after a 2012 Supreme Court case made the expansion optional. States that fully implemented the health care reform law saw an increase in residents with health insurance atnearly double the rate of the GOP-controlled states that didn’t.

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The Affordable Care Act is covering people, holding down costs and not killing jobs

By Jared Bernstein October 11 at 6:00 AM
Jared Bernstein, a former chief economist to Vice President Biden, is a senior fellow at the Center on Budget and Policy Priorities and author of the new book 'The Reconnection Agenda: Reuniting Growth and Prosperity.'

I’m on a panel this morning talking about the impact of the Affordable Care Act on the broader economy.

My rap starts from the perspective that the ACA, while not perfect, is working remarkably well. The ACA debate, on the other hand, has become inseparable from intense partisan politics and this has led to incessant hand-waving and smoke-blowing such that it’s impossible to get the straight dope on its impact.

Supporters aren’t blameless, as we should have expected (and warned people) that a complex policy dealing with a sector that’s 17 percent of GDP is going to get some things wrong out of the gate. To this day, the ACA needs recalibration (e.g., “thin” individual markets with too few providers).

But the idea that it should be repealed flies in the face of these facts:

Fact 1: The ACA has had the truly remarkable — almost unprecedented — impact of lowering the share of Americans without health coverage.The first figure shows that there are two times over the past 60 years or so that the uninsured rate fell sharply: the implementation of Medicaid/Medicare and that of the ACA. Any student of public policy knows that this is much harder than it looks. It’s all too rare for the enactment of a major public policy to quickly have its intended effect the way you see here.


Source: Council of Economic Advisers

Fact 2: The efficiencies in health-care delivery that the ACA has helped to usher along are one reason both spending and prices in the sector are growing more slowly. Also remarkable is the fact that current projections for future health spending are below those from January 2010, before the ACA was legislated, meaning these earlier forecasts did not include either the Medicaid expansion or the premium subsidies in the exchanges. As budget expert Richard Kogan recently noted, “As a result, overall health spending is not only projected to be lower but also to cover 20 million more people.”

Fact 3: There’s no evidence for the claim that the ACA a “job killer.” We are in the midst of the longest period of continuous job growth on record and the job market is closing in on full employment enough that the Federal Reserve is talking about raising interest rates to prevent overheating (based on the absence of inflationary pressures, I wouldn’t go there, but that’s a different discussion). But is there any evidence that’s a bit more ACA-specific?

The first two figures below are scatterplots where each dot is a state. As noted, ACA’s Medicaid expansion and premium subsidies have boosted insurance coverage, so one way to test the job-killer hypothesis is to plot changes in employment growth by state against changes in insurance coverage (this figure shows 2013-2015 changes, but the results are the same for one-year changes). If the ACA killed jobs, states with the biggest gains in insured rates should have seen slower job growth.[img]file:///C:/Users/ADMINI~1/AppData/Local/Temp/enhtmlclip/Image.png[/img]


Source: BLS, ACS

But the correlation goes the other way. The positive slope in the first figure means that states with bigger health-coverage gains were also the states with faster job growth. Of course, this was a period with pretty strong job growth, and the correlation could be driven by private, employer-sponsored coverage. But the second figure, which takes employer coverage out of the equation, shows a flatter but still positive correlation.


Source: BLS, ACS

To be clear, while there’s evidence that the ACA has led to increased job growth in the health-care industry, as you’d expect, I don’t think those positive slopes mean the ACA is a job creator. There are many moving parts to that machine, and the scatterplots are picking up only correlation, not causation. But I do think those positive slopes are not negative slopes: I’ve seen no evidence-based case that the ACA is dampening job growth.

What about job growth in the Medicaid expansion vs. the non-expansion states? The bar chart below shows that the rate of job growth was essentially the same in both groups (the small differences between the heights of the bars are statistically insignificant).


Source: BLS

Okay, but what about the shift to part-time jobs? The ACA requires employers with at least 50 full-time workers to offer health coverage to employees who work at least 30 hours a week or pay a penalty. So the incentive to shift full-time workers to part-time schedules exists. But let’s again go to the evidence.

If this incentive was in play, we’d expect to see an increase in the share of workers who were involuntary part-timers (IPTs), i.e., those who want to work full time but are stuck working part time. In fact, the share of IPTs (as a share of employment) shot up in the recession, well before the ACA was on the scene. But as the job market has come back, it has fallen sharply, as you see in the figure below.



Source: BLS, my analysis

However, it’s a highly cyclical variable: it always goes up in recessions (shaded area in figure) and down in recoveries. The question then becomes, is it falling more slowly in this recovery because of the ACA? To answer that, I built a simple statistical model to predict the ups and downs of the IPTs, and estimated it up to 2010, pre-ACA. I then forecast it forward. If the ACA was slowing the expected decline in IPTs, the forecast line would fall faster than the actual line. The fact that both lines track each other pretty closely suggests that the IPTs are declining as you’d expect, given the improving job market.

Like I said, the ACA isn’t perfect (I noted the individual market problem above, but remember: a) only 6 percent of those with coverage are in the non-group market, and b) a public option is a simple solution to this problem). But it’s a vast improvement over what came before, it’s providing affordable coverage to millions, it’s holding down costs beyond many of our expectations, and it’s not hurting job growth.

Those who want to repeal it need to convincingly explain how their plan achieves these goals, and trust me, they’ve not even begun to do so. That’s because their true motivation is because it’s “Obamacare.” And that, my friends, is no plan at all.