by Karen Telleen-Lawton, Noozhawk Columnist (read the original in Noozhawk by clicking here)
The Affordable Care Act, or Obamacare, is a dozen years old: practically part of the landscape. Having been a political wrecking ball for most of its life, one might expect its performance to be battered. The opposite is true.
In this year’s current enrollment period, the ACA exchanges overall offer lower premiums and more choices for more people in 2022. What’s more, studies are beginning to emerge showing other social benefits of health care provision.
Nationwide, a record-breaking 12.2 million Americans enrolled in the ACA through mid-September. This reflects 2.8 million who requested coverage during a six-month special enrollment period the Biden administration offered in 2021.
Over time, health care prices are still on an upward trajectory. But the slope of the curve has eased dramatically. Health insurance premiums rose by about 8% per year in the decade before the ACA. The decade following has averaged a 4% increase.
For a fourth year in a row, average medical insurance premiums have dropped under the ACA. This reflects a more competitive marketplace, as well as the experience providers have gained in assessing and pricing health care needs. The benchmark silver plan declined in price by 3% for those states participating in the federal exchange, according to a healthcare.gov report.
The price performance is even more remarkable considering 2021’s skyrocketing inflation of more than 6%.
“While inflation seems to be increasing prices for a lot of the products that we need and use, when it comes to health care at the Affordable Care Act exchanges, there’s a good chance you’ll see a drop in the price of your premiums,” Health and Human Services Secretary Xavier Becerra explained on CNN.
California’s version of the ACA is called Covered California. Peter V. Lee is retiring in February after directing Covered California since its inception.
Under Lee’s leadership, the increases over the past three years averaged just 1.1%; a mere 1.8% for 2022. A dozen insurers are offering plans, including premium reductions from four insurers: Anthem, L.A. Care, Molina, and Sharp.
Insured rates and prices are important, but the actual coverage provided is paramount. Covered California’s requirements for insurance companies have improved this area as well. Insurers cannot refuse to cover pre-existing conditions or deny certain benefits, such as mental illnesses and maternity or other services for women.
Another provision is that California insurers must report annual steps they’ve taken to reduce health disparities among ethnic, racial and income groups.
Insurers initially balked at these requirements, and many threatened to pull out of the market — or did. But a healthy marketplace has developed based on the sheer size of California’s population. With these protections, California lowered its uninsured rate 11 points to 7.7% in 2019.
Insuring vulnerable residents has affected other important measures of societal health. The Medicaid expansion portion of the ACA has been associated with 19,200 fewer deaths among older low-income adults from 2013 to 2017. This is almost one third more prevented deaths than in non-Medicaid-expansion states.
A study reported in Health Affairs in 2019 assessing eviction rates in California found Medicaid expansion was “associated with improved housing stability.”
Another analysis, this one by the University of Denver, found the ACA to be responsible for a sharp decline in bankruptcy risk. The bankruptcies prevented stemmed mainly from workers who were episodically employed and often uninsured before the ACA.
Anyone requiring medical care knows there’s always room for improvement. For instance, the uninsured rate for Latino residents in California was 12.66% despite our overall 7.7% rate. A significant improvement would be to erase the disparity in enrollment rates related to race and income level.
I expect and hope that in years to come we’ll hear statistics suggesting improvements in health. Better access to health care will lower rates of obesity and diabetes. Heck, maybe there will be a run on the vegetable market.
When we all have access to medical care, we will present as healthy, productive citizens.
Karen Telleen-Lawton, Noozhawk Columnist
Karen Telleen-Lawton is an eco-writer, sharing information and insights about economics and ecology, finances and the environment. Having recently retired from financial planning and advising, she spends more time exploring the outdoors — and reading and writing about it. The opinions expressed are her own.