As CBO made clear, however, its analysis was not a comprehensive analysis of how the ACA will affect the labor market in particular or the economy as a whole. As of January 1, more than 2 million people had selected a plan in the health insurance marketplace, and nearly 80 percent of those people will — thanks to the ACA — benefit from tax credits to help pay their premiums. In , 11 million people are estimated to benefit, rising to 19 million in Many millions more will gain affordable health insurance coverage through Medicaid.
These provisions of the ACA make it easier for families to access health care services and to meet other pressing needs, which will increase the demand for goods and services throughout the economy at a time when the unemployment rate is still elevated.
The United States is currently experiencing a historic slowdown in the growth of health care costs. From to real per-capita health spending grew at an average annual rate of just 1. The spending growth rates recorded over the last few years are the slowest on record, and less than one-third the long-term historical average of 4. As documented in a report by the Council of Economic Advisers, the ACA is contributing to these trends through reforms to Medicare that reduce excessive payments to medical providers and private insurers and by deploying innovative new payment models that incentivize more efficient, higher-quality care.
A growing body of evidence suggests that, in addition to reducing costs and improving quality in Medicare, these ACA reforms may be generating similar benefits system-wide. Slower growth in health care costs reduces the growth of the health insurance premiums paid by employers, which has important benefits for workers.
In the short run, lower health insurance premiums reduce the cost of hiring an additional worker, making it easier for employers to add jobs. One study co-authored by a leading health economist found that reductions in health care cost growth due to health care reform could increase job growth by , to , per year by the second half of this decade. Economic research shows that, over time, an increasingly large fraction of the premium savings are passed on to workers in the form of higher wages. Reducing our long-term deficit and laying the foundation for future growth.
CBO estimates that over the decade from through , the ACA will reduce the deficit by an average of 0. After the law was enacted, the Supreme Court took up a legal challenge to the individual mandate.
The plaintiffs sued to have the individual mandate voided as unconstitutional. In the run-up to the court decision, RAND analyzed the likely effect of eliminating the individual mandate and found that without it, an estimated 12 million people who would otherwise sign up for coverage would be uninsured.
The analysis found that eliminating the individual mandate would cause the number of people enrolled in the individual exchanges to fall by more than 20 percent. During the early enrollment period, debate erupted over the enrollment of young adults in the individual exchanges.
Some news stories and commentators maintained that unless roughly 40 percent of enrollees in the individual exchanges were young adults — between ages 18 and 34 — then the costs associated with older, less healthy adults would lead to higher premiums and ultimately destabilize these markets. At the end of the first open enrollment period in March , enrollment figures from the U. Department of Health and Human Services showed that 28 percent of enrollees were between the ages of , while 48 percent were 45 or older.
In addition, the spending data used as input to COMPARE suggest that, for most enrollees of all ages, premium payments exceed health care spending. To encourage enrollment in the new individual insurance exchanges, the ACA offers tax credits to help lower-income individuals and families buy coverage.
These tax credits have faced multiple court challenges. In late , the U. Supreme Court agreed to hear King v Burwell , a case that challenges the legality of government subsidies that help low- and moderate-income people buy health insurance in marketplaces operated by the federal government.
The legal challenge to these subsidies rests on the grounds that the wording of the law allows such aid only to people who buy policies through state-run marketplaces. They estimated that eliminating subsidies for low- and moderate-income people who purchase ACA-compliant plans would reduce enrollment in those 34 states from Of these, 8 million would be left uninsured. This analysis was widely cited in the debate in the run-up to the case in amicus briefs submitted to the Court before it heard oral arguments in March, Another unanticipated swerve along the path to implementation took place in , when the Supreme Court ruled that the federal government could not require states to expand Medicaid.
The ruling thus left expansion up to the states. In the wake of this decision, roughly half of the states have expanded Medicaid and half have not. RAND analysis found that Medicaid expansion is a boon for states: it boosts state economies and benefits the poorest residents by expanding their access to coverage and care and reducing their health spending and exposure to catastrophic medical costs.
As of late , momentum seemed to be swinging toward expansion. Additional states had either come around to expanding Medicaid Pennsylvania or were reconsidering their earlier decision not to expand Wyoming. This mandate, aimed at larger firms those with 50 or more employees , requires that firms offer coverage to employees who work at least 30 hours per week. RAND analysis estimated that the effect would be the opposite: that the number of workers receiving employer offers of coverage would actually increase.
Early enrollment numbers from confirmed that most of the newly insured in the U. During the initial rollout in , political pressure and angst in the business community led the Obama administration to delay enforcement of the employer mandate for a year and then extend the delay for some firms an additional year, until As a result, exchange enrollment has been a disappointment and the percentage of workers obtaining their health benefits from their employer has decreased steadily.
Access to health care has been uneven, with those on Medicaid hampered by narrow networks, while those on the exchanges or getting employer benefits have faced high out-of-pocket costs. The second category relates to cost containment. President Obama claimed that the ACA provided significant cost containment, in that costs would have been even much higher if the ACA was not enacted.
Further, he attributed cost reductions generally to the ACA, not taking into account factors such as the recession, increased out-of-pocket costs, increasing drug prices, and reduced coverage by insurers. The final goal was improvement in quality. The effort to improve quality has led to the creation of dozens of new agencies, boards, commissions, and other government entities.
In turn, practice management and regulatory compliance costs have increased.
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