The end of the year is always a good time to reflect on what went right and what didn’t and to speculate about what might happen in the coming 12 months.
So let’s take a look at how the U.S. health care system changed in 2014—the first year of close-to-full implementation of Obamacare—and take note of what we need to address sooner rather than later as we get ready to ring in the new year.
There is plenty of reason to celebrate and, as you can imagine, the White House wants us to believe that we can thank the Affordable Care Act for all the good things that happened. While I’m willing to give the law its due, the reality is that, as written, it will never get us to universal coverage or do nearly enough to control health care costs. But first, some of the good news:
- As the number of newly insured Americans reached an estimated 9.7 million this year, the percentage of Americans without coverage fell to the lowest level it’s been in years. That’s according to the National Center for Health Statistics, which released data last Thursday showing that the percentage of uninsured Americans dropped from 14.4 percent in 2013 to 11.3 percent in the second quarter of 2014. The White House Council of Economic Advisors says that’s the largest drop in at least four decades. The last time so many people gained coverage in a single year was when the Medicare and Medicaid programs began enrolling folks in 1966. The current gains were made possible by provisions of the Affordable Care Act that make it illegal for insurers to turn down applicants because of pre-existing conditions, as well as the availability of federal subsidies that help millions of Americans with their premiums and out-of-pocket spending.
- Health care inflation has been tamed—at least for the foreseeable future. The big accounting firm PricewaterhouseCoopers (PwC) said earlier this year that health care inflation was expected to slow to 6.5 percent in 2014, a full point less than the 7.5 percent inflation rate for 2013. PwC attributes at least part of that decline to the Affordable Care Act and suggests the trend likely will continue throughout 2015 and probably longer. “Total spending will rise with the cost of caring for the newly insured,” the report said, “but the rate of growth, which is based on unit costs, should remain at some of the lowest levels since the government began measuring national health expenditures in 1960.”
- The health care disparity gap is finally narrowing. Research reported recently by the New England Journal of Medicine found that racial disparities were reduced in every one of 17 quality measures for heart attacks, heart failures and pneumonia between 2005 and 2010. Another study, by researchers at the Urban Institute, found that the health insurance disparity gap is also narrowing as a result of the Affordable Care Act. The Institute predicts the Hispanic uninsured rate will drop from 31 percent to 19 percent by 2016 while the uninsured rate for blacks will drop from 20 percent to 11 percent.