After two years, hard to call ACA anything but a success

Marianne Udow-Phillips is director of the Center for Healthcare Research & Transformation.

It is hard to believe that as the Affordable Care Act turns five on March 23, it continues to be as controversial as it was on day one. The U.S. House of Representatives has taken 56 votes to repeal all or some of the landmark health care reform law, most recently in February. Earlier this month, the U.S. Supreme Court heard another ACA case with significant and far-reaching implications for the law’s future. Governors and legislatures across the country are continuing to debate whether or not to expand Medicaid. And legal and policy debates about contraceptive coverage and other components of the law are ongoing with no end in sight.

Yet against great odds, the ACA is having a profound effect on coverage and care across the country and in Michigan.

The second year of the ACA’s individual health insurance market coverage expansions came to a formal close on February 15. The first year of the Medicaid expansion in Michigan ends on March 31.

What has been the ACA’s actual impact in Michigan?

The answer is in the numbers. While there have certainly been negative effects for some individuals and businesses, it is hard to argue that the ACA’s coverage expansions, health system reforms and economic impacts at large have not positively affected hundreds of thousands in our state (and will be a topic of discussion at our Center’s March 26 symposium).

One has only to add up the numbers:

In Michigan, about 272,000 people received individual coverage through the Health Insurance Marketplace in 2014, blowing through all predictions made at the federal level. In 2015, Michigan exceeded 341,000 covered through the Marketplace. In 2014, 87 percent of these individuals have received a subsidy (making the upcoming U.S. Supreme Court case on this issue profoundly important). Many now covered on the Marketplace were able to get health insurance for the first time.

By early March, more than 579,000 people received coverage under the Healthy Michigan Plan, the state’s expanded Medicaid program, exceeding the state’s first-year enrollment predictions in just 10 months. The vast majority of these individuals were also uninsured before the expansion.

Data shows that despite some predictions otherwise, employers have not dropped coverage as a result of the ACA. In fact, employer-sponsored coverage continues to be the way most U.S. employees get their health insurance coverage. In 2014, 71.4 percent of non-elderly employees had employer-sponsored insurance nationally, up slightly from the 71.2 percent who had it in 2013.

As a result of these coverage changes, Michigan’s uninsured rate dropped by half between 2012 and 2014, based on CHRT’s most recent survey of Michigan adults. It does not appear that patients are experiencing access problems as nearly 9 out of 10 survey respondents (87 percent) reported that it was not difficult getting a primary care appointment.

Michigan has received almost half a billion dollars in federal funding for grants and demonstration projects since the ACA’s inception. These funds have gone to efforts such as increasing access to care at federally qualified health centers, expanding early childhood home visitation programs, and implementing new models of innovation like the grant recently awarded to the state for $70 million to test a variety of approaches to improving coordination of care and innovations in reimbursement.

Hundreds of providers across the state are testing new models of reimbursement and care integration under the ACA through initiatives like Accountable Care Organizations and bundled payment demonstration projects. The federal government extended one of these initiatives, the Michigan Primary Care Transformation Project, for another two years because it demonstrated first-year savings of $148 per beneficiary for Medicare alone.

In light of these real, tangible and measurable accomplishments, it is hard to understand why the focus by some in Washington continues to be on getting rid of the law rather than strengthening it.

There is no question that the ACA is complicated and needs changes to fully achieve the goals it set out to accomplish. But in just five years, the law has given hundreds of thousands in our state a chance they never had before: access to health care.

Let’s not lose that focus as we go forward in 2015 and beyond.