- Joined
- Aug 10, 2013
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With the Affordable Care Act's 15th birthday coming up on Sunday (my, how time flies!), lots of retrospective pieces are starting to pop up.
Despite plenty of unfinished business, the basic facts are worthy of celebration. Uninsurance plummeted, hitting an all-time low in 2023, with 45 million Americans insured directly under options created by the ACA last year. Health care cost growth since the ACA passed has been the lowest on record--the only sustained period of bending the cost curve ever. And the demonstrable positive impacts on quality and people's health outcomes have been quite exciting.
But the implementation has been a rocky experience, with lots of twists and turns. What have we learned? Three potential takeaways:
The Affordable Care Act At Fifteen: Policy Surprises And Lessons
I agree with those, though the third one is kind of nuanced. But if Dems had known how much health care cost growth would plummet and how much more important more generous subsidies were than an individual mandate, the last 15 years could have been quite different politically.
Lots more learnings one could add to the list, but for me it's the perhaps underappreciated overriding importance of income inequality. Despite the ACA being perhaps the biggest inequality reducing piece of legislation in decades, something upstream of it still seems broken. If you had told me 15 years ago that the cost curve would bend (something I didn't think would happen until the 2020s) and that per capita health care costs would fall as a portion of disposable per capita income, I would have imagined most people would feel that. But it doesn't seem to have registered, which suggests that the 'real' problem is potentially one of inequality, if arresting (or even reversing on a per capita income basis) health cost growth still leaves people feeling left behind. Still musing on that one.
Despite plenty of unfinished business, the basic facts are worthy of celebration. Uninsurance plummeted, hitting an all-time low in 2023, with 45 million Americans insured directly under options created by the ACA last year. Health care cost growth since the ACA passed has been the lowest on record--the only sustained period of bending the cost curve ever. And the demonstrable positive impacts on quality and people's health outcomes have been quite exciting.
But the implementation has been a rocky experience, with lots of twists and turns. What have we learned? Three potential takeaways:
The Affordable Care Act At Fifteen: Policy Surprises And Lessons
I agree with those, though the third one is kind of nuanced. But if Dems had known how much health care cost growth would plummet and how much more important more generous subsidies were than an individual mandate, the last 15 years could have been quite different politically.
Lots more learnings one could add to the list, but for me it's the perhaps underappreciated overriding importance of income inequality. Despite the ACA being perhaps the biggest inequality reducing piece of legislation in decades, something upstream of it still seems broken. If you had told me 15 years ago that the cost curve would bend (something I didn't think would happen until the 2020s) and that per capita health care costs would fall as a portion of disposable per capita income, I would have imagined most people would feel that. But it doesn't seem to have registered, which suggests that the 'real' problem is potentially one of inequality, if arresting (or even reversing on a per capita income basis) health cost growth still leaves people feeling left behind. Still musing on that one.