The Affordable Care Act is Working
Targeted News Service |
Thank you very much, Alice. It's an honor to be introduced by one of my personal heroes.
Alice, for those who don't know, was the founding Director of the
I have a deep and abiding respect for the work you do here at Brookings. In examining a social issue, you take both the long-term view and the near-term view. You look at data. You analyze trends over time. You conduct smart, systematic, empirical research. You focus on those three words in your motto: "Quality. Independence. Impact."
All of these things are music to this former Budget Director's ears.
I want to take this opportunity today, to apply this analytical framework to health care - and specifically, to the question of how well the Affordable Care Act is working. Then I'd like to share with you how we plan to move forward.
As someone who has managed across business, government, and large philanthropies, I've come to believe strongly in the importance of measuring impact.
When it comes to the Affordable Care Act, the three measures I believe we ought to look at most closely are affordability, access, and quality.
Are more people getting covered? - access and affordability.
Are middle class families shielded from suffocating medical bills? - affordability.
Are we spending our dollars more wisely? - quality and affordability.
To all of these questions, I would submit to you that the answer is "yes."
When you consider the law through the lens of affordability, access, and quality, the evidence points to a clear conclusion: The Affordable Care Act is working - and families, businesses, and taxpayers are better off as a result.
Four years after
Fewer Americans are uninsured.
At the same time, we're spending our health care dollars more wisely, and we're starting to receive higher quality care.
Historical Context
As we walk through the evidence, I think it's worth putting things in some historical context.
As a country, we've been wrestling with the question of how to cover the uninsured for as long as there's been a
In 1912,
Eighty years ago, President
Sixty-five years ago,
Fifty years ago,
A few years later, another President told
That President was
Costs spiraled out of control, and health care became unaffordable for millions of families and businesses alike.
Taxpayers felt the effects as well. Of those who weren't priced out of the health care market, many were locked out because they had a pre-existing condition like diabetes or high blood-pressure. And many, who were fortunate enough to have insurance, did not receive a very high quality of care.
By the time
In 2009, we were spending
These rising costs took their toll on family budgets.
In 2007, a Harvard study (led by a certain professor with a bright future named
A few years later, the
Costs took a toll on businesses' bottom lines as well. If you ran a small business, you were paying up to 18% more per employee than larger firms for the same health care.
What were we getting for the higher health care costs we shouldered?
In 2010, the
While we're still not scoring well in these benchmarks -we are doing a lot better on some other measures of quality, which I'll get to.
By the time the Affordable Care Act was passed, tens of millions of Americans were uninsured ... millions more had coverage that wasn't there when they needed it ... and everyone felt the impact.
Too many Americans relied on the Emergency Room for basic medical care, and that impacted costs. Uninsured children were statistically more likely to go without things like immunizations and prescriptions ... and uninsured adults were more likely to have chronic health conditions, many of which went undiagnosed.
The system was not working either for millions of Americans who had insurance. Seventy-eight percent of people who went bankrupt due to medical bills actually had health insurance.
Just because you happened to have an insurance card, your care wasn't necessarily affordable if you got charged several thousand dollars for a ride in an ambulance because your plan didn't cover it.
Having an insurance card did not guarantee that you had access to the services you needed.
Having an insurance card did not mean your doctors were effectively coordinating so that you wouldn't end up taking tests twice or getting procedures you didn't actually need.
The Uninsured
Thanks to the Affordable Care Act, things are changing for the better.
Let's consider for a moment the evidence on the uninsured - we are making historic progress.
The Affordable Care Act addresses big impediments in health care: affordability, access, and quality. It expanded
During the last Open Enrollment, consumers could choose from an average of nearly 50 plans - and I have some news for you when it comes to choice and competition:
Today, we're able to announce that in 2015 there will be a 25% increase in the total number of issuers selling health insurance plans in the Marketplace.
There is already real evidence these plans are affordable: Recently, the
It's no surprise, therefore, that when folks evaluate the success of the law, the Marketplace receives much of the attention.
Back in March, news reports suggested it would take "something close to a miracle" to get to 6 million people.
Last week we announced that 7.3 million people signed up for Marketplace plans, paid their premiums, and accessed quality, affordable coverage.
7.3 million people is - to borrow a phrase from the Vice President - a big deal. But I'm here to tell you that this isn't the number we should be obsessing over.
Yesterday we released another significant number: 8 million people enrolled in
This is a very significant number - but I still think there's another measure that's even more important...
In just one year, we've reduced the number of uninsured adults by 26%.
Said another way, 10.3 million fewer adults are uninsured today than in 2013.
I firmly believe this is the key measure we should all be looking at, because it represents historic progress on an issue that has eluded our country for more than a century.
There isn't a business in America that wouldn't be ecstatic with this kind of growth.
Ultimately, every number tells a story. I want to share with you the story of
Robert's coverage took effect on
After prayer, perseverance, radiation and chemotherapy, Robert is now cancer-free. Without health insurance, the treatments that saved Robert's life would have cost him about
I want to read to you a few of Robert's own words: "I was not in favor of Obamacare," he said. "Last year I was not going to get health insurance. I was going to pay the penalty ... I'm very grateful to be where I am now ... I must be one of the luckiest people in the world. I'm going to live and work and be productive."
I would submit that Robert's story is not a story about politics ... It's not about left or right... It's about affordability. It's about access. It's about quality.
The Middle Class
When it comes to Americans who already had insurance, I'll be straightforward with you: Those of us who support this law, haven't done a very good job of explaining why middle-class families who already had insurance are better off.
If you think about a mom and dad sitting at their kitchen table, working out a family budget - it's a big deal that they're saving money and still getting better coverage and more financial security.
Many middle-class families have more money in their budgets because their insurance company is now required to spend at least 80% of their premium on their care - as opposed to things like marketing. Families have saved an average of
Meanwhile, millions of seniors are saving billions of dollars on their prescription drugs as we phase out the donut hole. More than 8.2 million seniors have saved more than
Middle-class families are also benefitting from the real security that comes with knowing your health coverage will be there for you when you need it. Families no longer have to worry about losing their homes or having their hard-earned savings wiped-out by an accident, or unexpected diagnosis.
There is security in knowing that if you lose your job, you can purchase Marketplace coverage, even if you have a pre-existing condition and that you won't lose your insurance just because you get sick, or get cut off if you need chemotherapy or a life-saving operation.
Businesses and Taxpayers
Ultimately, a healthier and more financially secure middle class is good for businesses, who benefit from a healthy workforce and consumers with more disposable income.
The Bipartisan Policy Center reported last week that businesses lose
Some of the biggest - and most positive - impacts that businesses and taxpayers feel from the law are in the area of costs.
Since
Across the board, we have now held down health care price inflation to the lowest rate in 50 years.
Premiums for employer-based coverage have been driven down as well. Earlier this month, Kaiser reported that this year's cost growth is the lowest on record. It's been projected that had premiums grown at the rate we saw over the previous decade - instead of the slower rate we've seen over the past four years - employer coverage would be
If you're an employer, this means it's easier for you to hire workers today. If you're an employee, it means you could be keeping more of your own paycheck tomorrow. If you're a taxpayer, it means a stronger economy.
Improvements to our health delivery system are also having an impact on costs to taxpayers as we spend dollars more wisely.
We've saved taxpayers
Or, in a further example, the
Our Plan to Move Forward
Taken together, I believe the evidence points to a clear conclusion: The Affordable Care Act is working.
My job as Secretary is to lead our efforts to make sure it continues to work and to work better. Every business in America worth its salt learns from both what went right, and what went wrong. We're taking the same approach, and we have a four-part strategy for moving forward:
First is improving access and affordability through the Marketplace. In order to make sure that Americans continue to access affordable choices, we have to get HealthCare.gov right.
To me, the formula for this is technology, management, and prioritization.
We are checking off outstanding items on last year's to do list; cleaning up the backend functionality; and adding functionality for renewing and enrolling in coverage.
We're prioritizing the most important items and areas to improve, consistent with our deadlines.
We're focused on giving ourselves the appropriate amount of time for testing.
And we're very focused on security.
Anyone who's ever managed a large scale technology project knows that these projects are challenging, and they sometimes require tough choices. We're prepared to make those choices so we can deliver the best consumer experience. Second is improving quality for patients and spending every dollar wisely. We're testing new models in
Changing incentives to move from a volume-based to a more impact-based system ...
Investing in tools that expand our capacity to change ..
Improving the flow of information, so doctors can spend more time with patients and less time doing paperwork - and so they can coordinate more effectively with one another. Third is expanding access by expanding
I'd like to close with one final thought...
As we work through these issues, I think we need a bit of a course correction in this country when it comes to how we talk about these issues - and it starts with collectively turning down the volume a bit.
Surely, we'd all agree that the back-and-forth hasn't been particularly helpful to anyone - least of all the hardworking families who we all want to help.
I prefer a Brookings, "quality, independence, impact-style" approach.
A small-business owner from
I want to read you a few of Betsy's own words:
"Recently, I was able to enroll my family - my entire family," Betsy wrote. "Not only is my son finally covered, our premium is only half what we were paying before. I was shocked to learn my prescriptions, which used to cost
Betsy, Robert, moms and dads working out their budget around the kitchen table ... they're all counting on us. They're our boss. And they deserve for this to work.
So let's move beyond the back-and-forth. Let's move forward, together.
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