Think You Can Do Better? The Obamacare Standard

Third Way's Resources on the GOP Health Care Bill

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David Kendall

Senior Fellow for Health and Fiscal Policy

@DavidBKendall

David Kendall, Senior Fellow for Health and Fiscal Policy

President Donald Trump and Congressional Republicans have vowed to end Obamacare and make U.S. health care better. That might make for a nice soundbite, but whether their approach will actually improve health care can be measured across a wide range of objective measures. Below, we lay out 20 areas where Obamacare achieved specific and quantifiable success. The question now is: will Republicans make these metrics better—or worse?

9 out of 10 working adults have health insurance.¹
3 out of 4 working-age adults have no gaps in coverage over the course of a year.²
19 out of 20 children have health insurance.³
No Americans are denied coverage due to pre-existing conditions such as pregnancy or cancer.⁴
No American is dying or going bankrupt because they exhausted their health care coverage.⁵
Employer-sponsored coverage has held steady.⁶
19 out of 20 older adults have health insurance.⁷
17 out of 20 young adults have health insurance.⁸
3 out of 4 adults living in poverty have health insurance.⁹
17 out of 20 Americans have complete preventive care coverage.¹⁰
17 out of 20 Americans have coverage for mental health and substance use at the same cost as physical health care.¹¹
98 out of 100 women in a health plan have guaranteed coverage for birth.¹²
Access to primary care through community health centers has increased steadily for the past five years, for a total increase of 25%.¹³
The number of primary care providers has grown steadily for the past five years, for a total increase of 18%.¹⁴
Hospitals have seen a steady decline in unpaid medical bills starting in 2012.¹⁵
For 22 out of 25 working-age adults, cost is not a barrier to seeing a specialist.¹⁶
4 out of 5 working-age adults do not have trouble paying for medical care.¹⁷
Health care inflation over the last six years has averaged one-half of 1%.¹⁸
By 2020, no Medicare beneficiaries with a Part D plan will have a “doughnut” hole in their prescription drug coverage.¹⁹
The ACA will reduce the deficit over the next 10 years by $137 billion under the most conservative estimate from the Congressional Budget Office.²⁰

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Endnotes

Under the Affordable Care Act (ACA), the portion of working adults with coverage rose from 81.5% in 2010 to 88.4% in 2015.

Sources: Author’s calculations based on United States, Department of Commerce, Census Bureau, Carmen DeNavas-Walt, Bernadette D. Proctor, and Jessica C. Smith, “Income, Poverty, and Health Insurance Coverage in the United States: 2010,” Current Population Reports, September 2011, p. 27. Accessed December 6, 2016. Available at: http://www.census.gov/library/publications/2011/demo/p60-239.html. See also United States, Department of Commerce, Census Bureau, Jessica C. Barnett and Marina S. Vornovitsky, “Health Insurance Coverage in the United States: 2015,” Current Population Reports, September 2016, p. 10. Accessed December 6, 2016. Available at: http://www.census.gov/library/publications/2016/demo/p60-257.html.
Under the ACA, the portion of working-age adults (18 to 64 years old) with continuous coverage throughout the year went from 57% in 2010 to 75.1% in 2016.

Source: United States, Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, Emily P. Zammitti, Robin A Cohen, and Michael E. Martinez, “Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, January-June 2016,” November 2016, p. A1. Accessed December 9, 2016. Available at: http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201611.pdf.
The ACA increased children with coverage from 90.2% in 2010 to 94.8% in 2015.

Sources: United States, Department of Commerce, Census Bureau, Carmen DeNavas-Walt, Bernadette D. Proctor, and Jessica C. Smith, “Income, Poverty, and Health Insurance Coverage in the United States: 2010,” Current Population Reports, September 2011, p. 26. Accessed December 8, 2016. Available at: http://www.census.gov/library/publications/2011/demo/p60-239.html. See also United States, Department of Commerce, Census Bureau, Jessica C. Barnett and Marina S. Vornovitsky, “Health Insurance Coverage in the United States: 2015,” Current Population Reports, September 2016, p. 7. Accessed December 6, 2016. Available at: http://www.census.gov/library/publications/2016/demo/p60-257.html.
The ACA has prohibited health plans from denying anyone coverage because they have a pre-existing condition. 53% of individuals say that they or someone in their household have a pre-existing condition.

Source: Gary Claxton, Cynthia Cox, Anthony Damico, Larry Levitt, and Karen Pollitz, “Pre-existing Conditions and Medical Underwriting in the Individual Insurance Market Prior to the ACA,” Issue Brief, The Henry J. Kaiser Family Foundation, December 2016, p. 1. Accessed December 15, 2016. Available at: http://kff.org/health-reform/issue-brief/pre-existing-conditions-and-medical-underwriting-in-the-individual-insurance-market-prior-to-the-aca/.
The ACA prohibits any private health plans (including grandfathered plans) from having a lifetime dollar limit on the amount of care covered as an essential benefit.

Source: United States, Department of Health and Human Services, “Lifetime and Annual Limits,” January 31, 2017. Accessed February 10, 2017. Available at: https://www.hhs.gov/healthcare/about-the-law/benefit-limits/index.html.
Before the ACA, coverage through employer-sponsored health insurance had been steadily declining from 63% in 2002 to 59.8% in 2007. Under the ACA, employer coverage held steady starting at 55.4% in 2010 and increasing to 55.7% in 2015.

Sources: United States, Department of Commerce, Census Bureau, Current Population Survey Table Creator. Accessed December 14, 2016. Available at: http://www.census.gov/cps/data/cpstablecreator.html. See also United States, Department of Commerce, Census Bureau, Carmen DeNavas-Walt, Bernadette D. Proctor, and Jessica C. Smith, “Income, Poverty, and Health Insurance Coverage in the United States: 2010,” Current Population Reports, September 2011, p. 23. Accessed December 8, 2016. Available at: http://www.census.gov/library/publications/2011/demo/p60-239.html. See also United States, Department of Commerce, Census Bureau, Jessica C. Barnett and Marina S. Vornovitsky, “Health Insurance Coverage in the United States: 2015,” Current Population Reports, September 2016, p. 1. Accessed December 8, 2016. Available at: http://www.census.gov/library/publications/2016/demo/p60-257.html.
Under the ACA, coverage of adults aged 45-64 has increased from 83.7% in 2010 to 90.4% in 2015.

Sources: United States, Department of Commerce, Census Bureau, Carmen DeNavas-Walt, Bernadette D. Proctor, and Jessica C. Smith, “Income, Poverty, and Health Insurance Coverage in the United States: 2010,” Current Population Reports, September 2011, p. 26. Accessed December 8, 2016. Available at: http://www.census.gov/library/publications/2011/demo/p60-239.html. See also United States, Department of Commerce, Census Bureau, Carmen DeNavas-Walt, Bernadette D. Proctor, and Jessica C. Smith, “Income, Poverty, and Health Insurance Coverage in the United States: 2011,” September 2012, p. 65. Accessed February 10, 2017. Available at: http://www.census.gov/library/publications/2012/demo/p60-243.html. See also United States, Department of Commerce, Census Bureau, Jessica C. Barnett and Marina S. Vornovitsky, “Health Insurance Coverage in the United States: 2015,” Current Population Reports, September 2016, p. 7. Accessed December 8, 2016. Available at: http://www.census.gov/library/publications/2016/demo/p60-257.html.
Under the ACA, coverage of young adults (ages 19-25) climbed from 70.3% in 2010 to 85.5% in 2015.

Sources: United States, Department of Commerce, Census Bureau, Carmen DeNavas-Walt, Bernadette D. Proctor, and Jessica C. Smith, “Income, Poverty, and Health Insurance Coverage in the United States: 2010,” Current Population Reports, September 2011, p. 26. Accessed December 8, 2016. Available at: http://www.census.gov/library/publications/2011/demo/p60-239.html. See also United States, Department of Commerce, Census Bureau, Jessica C. Barnett and Marina S. Vornovitsky, “Health Insurance Coverage in the United States: 2015,” Current Population Reports, September 2016, p. 7. Accessed December 8, 2016. Available at: http://www.census.gov/library/publications/2016/demo/p60-257.html.
The ACA has increased coverage for adults living in poverty from 58% in 2010 to 74% in 2015.

Source: United States, Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Kelsey Avery, Kenneth Finegold, and Amelia Whitman, “Affordable Care Act Has Led to Historic, Widespread Increase in Health Insurance Coverage,” Issue Brief, September 29, 2016, p. 10. Accessed February 10, 2017. Available at: https://aspe.hhs.gov/pdf-report/affordable-care-act-has-led-historic-widespread-increase-health-insurance-coverage.
The ACA requires most private health plans, Medicare, Medicaid, and Department of Defense plans to cover preventive services that have strong evidence of effectiveness at no charge to beneficiaries. It increased complete coverage for prevention from 43.4 % of the population in 2010 to 85.3% in 2014.

Source: United States, Author’s calculations based on United States, Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, “ASPE Data Point: The Affordable Care Act is Improving Access to Preventive Services for Millions of Americans,” May 14, 2015. Accessed February 10, 2017. Available at: https://aspe.hhs.gov/pdf-report/affordable-care-act-improving-access-preventive-services-millions-americans.
The ACA requires most private health plans to cover mental health and substance use disorders and for the cost sharing to be the same as for physical health care (known as parity). It increased such coverage from a level no higher than 72.8% in 2011 to 85.3% in 2014.

Sources: United States, Author’s calculations based on United States, Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Kirsten Beronio, Rosa Po, Laura Skopec and Sherry Glied, “Affordable Care Act Will Expand Mental Health and Substance Use Disorder Benefits and Parity Protections for 62 Million Americans,” February 2013. Accessed February 10, 2017. Available at: https://aspe.hhs.gov/report/affordable-care-act-expands-mental-health-and-substance-use-disorder-benefits-and-federal-parity-protections-62-million-americans. See also United States, Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, “ASPE Data Point: The Affordable Care Act is Improving Access to Preventive Services for Millions of Americans,” May 14, 2015. Accessed February 10, 2017. Available at: https://aspe.hhs.gov/pdf-report/affordable-care-act-improving-access-preventive-services-millions-americans.
Under the ACA, the number of women (ages 18-64) with a health plan that is guaranteed under the law to cover maternity increased from 86% in 2011 to 98% in 2015.

Sources: Author’s calculations based on Louise Norris, “Do all Health Insurance Plans Cover Maternity?” Healthinsurance.org, October 3, 2015. Accessed February 12, 2017. Available at: https://www.healthinsurance.org/faqs/do-all-health-insurance-plans-cover-maternity/. See also “Health Insurance Coverage of Women 19-64,” Kaiser State Facts, 2015. Accessed February 12, 2017. Available at: http://kff.org/other/state-indicator/nonelderly-adult-women/?dataView=1&currentTimeframe=0. See also United States, Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Benjamin D. Sommers, “Number of Young Adults Gaining Insurance Due to the Affordable Care Act Now Tops 3 Million,” June 19, 2012. Accessed February 12, 2017. Available at: https://aspe.hhs.gov/basic-report/number-young-adults-gaining-insurance-due-affordable-care-act-now-tops-3-million#end1. See also Charles Gaba, “How many Grandfathered or Transitional plans are still around anyway?” ACA Signup.Net, February 24, 2016. Accessed February 12, 2017. Available at: http://acasignups.net/16/03/24/how-many-grandfathered-or-transitional-plans-are-still-around-anyway. See also Women’s Health Insurance Coverage, Kaiser Family Foundation, October 2012. Accessed February 12, 2017. Available at: http://bit.ly/2kn5umE. See also United States, Department of Health and Human Services, Agency for Healthcare Research and Quality, 2011. Accessed February 12, 2017. Available at: https://meps.ahrq.gov/mepsweb/.
The number of patients served by community health centers has steadily increased every year since the ACA’s enactment with 19,469,467 patients served in 2010 to 24,295,946 in 2015, a 25% increase.

Source: United States, Department of Health and Human Services, Health Resources and Services Administration, “Health Center Program: Data Comparisons,” 2010 to 2015. Accessed February 14, 2017. Available at: https://www.bphc.hrsa.gov/uds/datacomparisons.aspx.
From 2010 to 2015, the number of primary care providers (family and general physicians, OB GYNs, pediatricians, internists, physician assistants, and nurse practitioners) increased from 90.3 to 100.8 per 100,000 people.

Source: Author’s calculations based on United States, Department of Labor, Bureau of Labor Statistics, “Occupational Employment Statistics,” May 2010 to May 2015. Accessed February 10, 2017. Available at: https://www.bls.gov/oes/tables.htm.
Uncompensated care has declined from 5.8% of the average community hospital’s operating cost in 2010 to 4.2% in 2015.

Source: American Hospital Association, “Uncompensated Hospital Care Cost Fact Sheet,” December 2016. Accessed February 13, 2017. Available at: www.aha.org/content/16/uncompensatedcarefactsheet.pdf.
The number of working-age adults (19-64) for whom cost is not a barrier to seeing a specialist has increased from 83% in 2010 to 88% in 2016.

Source: “Biennial Health Insurance Survey, 2003-2016,” Commonwealth Fund. Accessed February 14, 2017. Available at: http://www.commonwealthfund.org/interactives-and-data/surveys/biennial-health-insurance-surveys/2017/biennial-explorer.
The number of working-age adults (19-64) who have not had trouble paying for health in the last year has increased from 74% in 2010 to 80% in 2016.

Source: “Biennial Health Insurance Survey, 2003-2016,” Commonwealth Fund. Accessed February 14, 2017. Available at: http://www.commonwealthfund.org/interactives-and-data/surveys/biennial-health-insurance-surveys/2017/biennial-explorer.
From 2010 to 2015, health care inflation as measured by the difference between the annual per capita growth in national health expenditure and the annual growth the per capita GDP, 0.5%. That inflation rate as lower for every other six year period except for three times under President Clinton..

Source: Author’s calculations based on United States, Department of Health and Human Services, Centers for Medicare and Medicaid Services, “National Health Expenditures by Type of Service and Source of Funds, CY 1960-2015.” Accessed February 13, 2017. Available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html.
The ACA phases out the doughnut hole, which is a gap in coverage for prescription drugs after a patient has had some initial drugs costs and before they have high drug costs.

Source: Patricia Barry, “Paying Less for Drugs in the Part D 'Doughnut Hole,’ ” AARP, May 2014. Accessed February 13, 2017. Available at: http://www.aarp.org/health/medicare-insurance/info-01-2011/ask_ms_medicare_question_92.html.
The ACA will reduce the deficit in the years 2021 to 2025 and increase the deficit from 2016 to 2020 for a net total of $137 billion in deficit reduction according the Congressional Budget Office’s analysis that includes macroeconomic effects on the economy.

Source: United States, Congress, Congressional Budget Office, “Budgetary and Economic Effects of Repealing the Affordable Care Act,” June 2015, p. 2. Accessed February 14, 2017. Available at: https://www.cbo.gov/publication/50252.