Beyond The Fog Of Spin And Doubt: What Has ACA Achieved?

The Affordable Care Act has made it possible for millions of Americans to obtain health insurance — but how successful has the law been in reforming the health care system?

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MELISSA BLOCK, HOST:

This is ALL THINGS CONSIDERED from NPR News. I'm Melissa Block in Dallas.

ROBERT SIEGEL, HOST:

And I'm Robert Siegel in Washington, where President Obama cheered the Affordable Care Act today.

PRESIDENT BARACK OBAMA: Despite several lost weeks out of the gate because of problems with the website, 7.1 million Americans have now signed up for private insurance plans through these marketplaces.

(SOUNDBITE OF CHEERING)

SIEGEL: The president marked a milestone with that number. It is the end of the first open enrollment for Obamacare, a good time to assess what the health care law has achieved so far. Polls show a majority of Americans still judge it unfavorably. Their opinions are shaped by a lot of factors: health, age, income, and where they live.

Here's NPR's John Ydstie.

JOHN YDSTIE, BYLINE: The main goal of the Affordable Care Act is to extend health insurance coverage to nearly 50 million uninsured Americans. Mark Pauly, of the University of Pennsylvania's Wharton School, says it's had some success.

MARK PAULY: For the people who formerly were uninsured who now have coverage, there's definitely a benefit. And you can sort of tick off the groups.

YDSTIE: For instance, poor people who now qualify for expanded Medicaid coverage; low-income Americans with no insurance through their job; young people under 26 who can now be covered by their parents' policy; and people like Oregon farmer Josh Simonson, who have pre-existing conditions.

JOSH SIMONSON: I was ineligible for any health care. I had been denied by five different companies because I'd broken some vertebrae in my back, and nobody wanted to cover me.

YDSTIE: After a disastrous start last fall, the ACA exchanges appear to have met the original projection for their first year of 7 million enrollees, with an additional 6 and a half million estimated to have signed up for Medicaid. But it's not clear how many of those people had insurance before and lost it, despite President Obama's assertion that if they liked their policy, they could keep it.

Illinois corn farmer Jamie Walter is one of them.

JAMIE WALTER: I received a letter from Blue Cross/Blue Shield of Illinois, informing me that my current insurance coverage would be canceled.

YDSTIE: Walter says he found a policy on the ACA exchange, but he's not happy with it.

WALTER: That plan cost us over 50 percent more a month.

YDSTIE: Walter says that's partly because it covers things he and his family don't need.

This situation raises another important question. Is the Affordable Care Act making health care more affordable? For Walter, the answer is no. But the answer is yes for people like Johanna Humbert, from Michigan. Her modest income qualifies her for a $300 a month subsidy.

JOHANNA HUMBERT: Currently, I pay $518. So it'll be a big savings for me.

YDSTIE: However, for another important group, insurance could cost more, says Mark Pauly, who was a health policy specialist for the first President Bush.

PAULY: For young, low-risk people, the consequence of the way the exchange is set up is going to be to raise their premiums if they're not low-income. So they actually have more of an incentive to walk away.

YDSTIE: The problem is that if too many young, healthy people walk away, health insurance costs on the exchanges could rise.

Affordability also depends on how competitive the health care market is where you live. NPR partner Kaiser Health News found that a middle-income family of four in southwest Georgia could face a premium of nearly $2,700 a month, while a similar policy in Beverly Hills would cost half that. And in Pittsburgh, it would be about a third of the price in Georgia.

More broadly, President Obama has argued the ACA has reined in health care cost increases overall. It is true that since 2009, they've increased at the slowest pace on record. But Uwe Reinhardt, a health care specialist at Princeton, says the government's actuaries concluded Obamacare isn't the reason.

UWE REINHARDT: Having said that, it is possible that in the future, the Affordable Care Act will contribute to cost containment. But claiming it now, I think, is a stretch.

YDSTIE: The ACA does contain several provisions aimed at reining in health costs. But Reinhardt cautions Americans not to expect Obamacare to fix the U.S. health care system.

REINHARDT: It's an ugly patch on an ugly system. By and large, it is a reaffirmation of the existing system.

YDSTIE: The Institutes of Medicine has concluded that America's complex system of insurance markets and health care providers wastes about a quarter of the $2.8 trillion spent annually on health care. Reinhardt says despite the changes made by Obamacare, Americans will likely continue spending much more per person on their health care than countries like Canada and Germany.

John Ydstie, NPR News, Washington.

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