The Affordable Care Act — also known as the ACA, Obamacare, the Devil’s Spawn, depending on your orientation — pretty clearly appears to be doing what it’s supposed to be doing: covering the uninsured and controlling costs. Yet it certainly doesn’t seem to be gettin’ the love from the press at anything like the rate that it got bashed after its lame rollout.
Analysts at the Urban Institute have been tracking the share of the adult population without coverage and in a particularly useful way: by comparing states with and without the Medicaid expansion. While the ACA is of course in effect in all states, 21 states have thus far decided not to take advantage of the Medicaid expansion offered by the law. Thus, we have a sort of natural experiment.
Since September 2013, right before the ACA’s first open enrollment period began, the percent of uninsured nonelderly adults has declined from about 18 percent to about 14 percent. Moreover, the fact that the decline has been considerably steeper in Medicaid expansion states gives more heft to the ACA explanation.
The table above shows that the percentage of uninsured adults fell about six points in expansion states and only 1.7 points in non-expansion states. Differencing these two numbers (taking the difference of a difference) provides a simple, first-blush test of the pseudo-experimental that’s playing out. (Thanks, SCOTUS.) The decline in non-coverage in expansion states is thus far outpacing the decline in non-expanders by 4.4 points.
Second, health-care costs have been rising a lot less quickly in recent years, and changes introduced by the ACA are implicated. Since 2011 (post ACA and post-recession), the personal consumption expenditure (PCE) price index for health care has gone up 1.6 percent per year, compared with about 3 percent per year, 2000-11. Of course, lots of moving parts here, but experts attribute some of this very favorable new trend to health-care delivery reforms in the ACA.
Look, for example, at the decline in hospital readmission rates, a costly problem that the ACA directly dis-incentivizes by penalizing hospitals with high readmission rates for a specific set of diagnoses.
Now, I’m not saying that there’s been a media blackout on good news of the type reported above, nor do I have quantitative evidence that there’s been much more negative than positive reporting on the ACA. But allow me to shed, for a brief moment, the mantle of statistical wonk moved only by numerical evidence and just assert the following: gimme a freakin’ break!
I will happily and publicly stand down if someone can prove otherwise, but my strong sense, and I’m a news junkie, is that the fix has been in on this. And sure, I get that “if-it-bleeds-it-leads.” I suppose “Big Government Program Working” isn’t a very sexy headline. Neither am I saying, of course, that the implementation of ACA is perfect or that it’s all smooth sailing ahead.
But man, in an era when faith in government to get something this important right is so deeply shaken, it would be really useful to see a lot more balance here.