Call me cheap, but I just don’t think we can afford to lose the ACA. Six years have transpired since the 2014 passage of the Affordable Care Act. Data have been rolling in from 50 experiments in 50 states. What have we learned about providing health care coverage in that time?
The most dramatic are the recent results of a nationwide study presented during a 2020 ASCO Virtual Scientific Program. The study revealed that the 27 states (including California) that expanded Medicaid under the ACA lowered their rates of cancer 20% more than the non-Medicaid expansion states.
That is, 785 fewer people lost their lives; moreover, nearly 600 deaths could have been prevented in the 23 non-ACA states.
Significantly, this statistic counted only cancer patients under age 65 (since seniors already had coverage under Medicare). From an economics perspective, this implies 785 citizens are still leading productive lives and paying taxes.
One study leader, Dr. Anna Lee of Memorial Sloan Kettering Cancer Center of New York, remarked, “For a policy to have this amount of impact in a short amount of years is remarkable because cancer often takes a long time to develop and prove fatal.”
Lee discussed the factors that make possible this lower death rate. For one, people with insurance generally have more opportunities for early cancer screening. Second, health insurance leads to more options and quicker treatment after diagnosis. This can improve the survival odds, according to Lee.
Deaths and taxes aren’t the only ways to measure ACA’s success, of course. Health care costs are still growing. Nevertheless, they are growing at a significantly lower pace since 2014. Private plan costs were increasing at a rate of about 9% in the years leading up to the ACA; now they are about a third of that. Likewise, Medicare plan increases have been slashed from almost 8% to 1.5% per year.
My friend Ponie might have benefited from the ACA. She waited until age 65 to take advantage of Medicare coverage for a couple non-emergency surgeries. Unfortunately, when she went in for the first one, it turned out to be cancer. The cancer had metastasized; she died before her 67th birthday.
One of the telling points about the effect of the ACA is its effect across various categories of Americans. The improved outcomes are spread across all socioeconomic levels, all races, all ages, urban as well as rural, and so forth. It has been a lifesaver for those with pre-existing conditions, seniors, workers without job-based coverage, self-employed workers, and small business owners.
Facts are paramount, but the most important metric for the ACA’s long-term survival is whether it is popular. In the first year of ACA, about 65% expressed that they were somewhat or mostly satisfied; this number grew to 82% in 2018.
With this promising beginning, it would appear the ACA has a rosy future. But there was a bump in the data even before COVID-19. In 2018 there was an uptick in the rate of uninsured Americans for the first time.
The uptick coincided with the reduction to zero dollars of the penalty for choosing not to be insured. This effectively ended the mandate on insurance coverage. The decrease in the number of insured Americans was less than 1% in 2018, but this coincides with 1.8 million people.
One silver lining in the horrible cloud of the pandemic may be the recognition by more Americans that managed health care is the road to better health at lower cost. I’m a practical woman. I’d like us to read the data and choose lower costs AND better care through managed health.
— Karen Telleen-Lawton serves seniors and pre-seniors as the principal of Decisive Path Fee-Only Financial Advisory in Santa Barbara. You can reach her with your financial planning questions at email@example.com. Click here to read previous columns. The opinions expressed are her own.