1. Obamacare: Myths and Realities
Janet Hankin, Sociology
Allen Goodman, Economics

2. Background

3. The Affordable Care Act a.k.a. Obamacare: What is it?
A major goal of the Affordable Care Act is to put American consumers back in charge of their health coverage and care.
It puts in place comprehensive health insurance reforms that will hold insurance companies more accountable, lower health care costs, guarantee more health care choices, and enhance the quality of health care for all Americans. 

4. How does it work? Expands Medicaid for states that want federal money
Subsidies to help small businesses and individuals w/ modest income to purchase private health insurance.
New marketplaces to purchase insurance by employers and individuals
More level competitive environment
Government will subsidize premiums for those 138%-400% of FPL

5. Uninsured
Insurance must now cover children regardless of their health problems
Cannot refuse adults coverage because of preexisting conditions
Now allows people under 26 to remain on parents’ health insurance plans
Insurers cannot charge sicker people more
Premiums must be fair and must not discriminate by sex

6. Incentives To Insure More Workers
As of 2016, if employers have 50 or more employees, they must provide coverage which meets minimum value and affordability standards, or pay $2K per employee.
Small employers get tax credits for providing coverage (< 25 workers).

7. Essential Health Benefits – 1
Ambulatory patient services
Emergency services
Hospitalization
Maternity and newborn care
Mental health and substance use disorder services, including behavioral health treatment

8. Essential Health Benefits – 2
Prescription drugs
Rehabilitative and habilitative services and devices (services and devices that help people keep, learn, or improve skills and functioning for daily living)
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services, including oral and vision care

9. Other Changes Stress on prevention and avoiding disease
Means earlier detection of illness when treatment costs less.
No copayments or deductibles for immunizations, screening for many illnesses from cancer to depression, checkups
Expand pool of primary care doctors and nurses—cost less than specialty care

10. The ACA Will Kill Jobs MYTH
Fear that employers will switch to part time workers to avoid provision of health insurance

11. The ACA Will Kill Jobs REALITY Not clear
Argument was premised that if a single employer must raise wages, costs will be too high, and they’ll lose money. This is not the same if ALL employers must raise wages. Similar to modern minimum wage arguments.
No evidence that there was a major switch to part-time workers.
Unemployment rate (August 2016) is slightly below 5%

12. The ACA Will Not Improve Health Care System
MYTH

13. The ACA Will Not Improve Health Care System
REALITY
The ACA Will Not Improve Health Care System
Sommers, et al. (2015), for found a clear downward trend among those reporting their health conditions as “fair or poor.” Analyses of subsamples, e.g., by race/ethnicity and by states that participated in Medicaid expansion vs. those that did not, revealed broad gains following the initial enrollment period.
Sommers, et al. (2016) determined that compared to Texas, Medicaid expansions in Kentucky and Arkansas led to “… major improvements in access to primary care and medications, affordability of care, utilization of preventive services, care for chronic conditions, and self- reported quality of care and health.”

14. The Number of Uninsured Will Not Decline
MYTH
Fear that Americans will not buy insurance on the health care exchange, healthcare.gov

15. The Number of Uninsured Will Not Decline
REALITY

16. The Number of Uninsured Will Not Decline
REALITY

17. States will not expand their Medicaid
MYTH
States will not expand their Medicaid

18. States will not expand their Medicaid
REALITY
States will not expand their Medicaid

19. 2015 Percent Uninsured by State
LT 10
10+
12+
14+
16+

20. 2013, 2014, 2015 – Percentage Uninsured
LT 10
10+
12+
14+
16+
2013
2014
2015

21. Access to Health Care under ACA Will Be Difficult
MYTH
Access to Health Care under ACA Will Be Difficult
Insurer competition in the marketplaces has led to the proliferation of health plans that offer a narrow, or limited, network of health care providers at a lower price than plans with broader networks.
This has led to concerns over access to care.

22. Access to Health Care under ACA Will Be Difficult
REALITY
Access to Health Care under ACA Will Be Difficult
More than half (54%) of people who were enrolled in a marketplace plan for the first time or who had changed plans said they had the option of choosing a less expensive plan featuring fewer doctors or hospitals. Of those, 41 percent selected the limited network plan.
Across all marketplace plans, more than three- quarters (78%) of enrollees who either recently enrolled or had changed plans reported being very or somewhat satisfied with the doctors covered by their insurance. Among these adults, 64 percent reported their plans have some or all of the doctors they want.

23. REALITY

24. REALITY

25. REALITY

26. Costs Will Rise under ACA
MYTH
Costs Will Rise under ACA

27. Costs Will Rise under ACA
SOME
VALIDITY
Costs Will Rise under ACA
Yes, in two ways. Yes, there was a major increase in enrollment, which grew faster than the economy. We have seen in the past that enrollment increases lead to expenditure increases, and growth in the NHE share.
Yes, in the sense that some transitions to managed care increased growth in costs. In a transition to managed care Medicaid, the net insurance cost rises as Medicaid Health Maintenance Organizations (HMOs) collect more in premiums than they pay out in benefits while government administrative costs are largely unaffected.

28. Costs Will Rise under ACA
ALSO
Costs Will Rise under ACA
Schoen (2016) argues that a number of ACA reforms, particularly related to Medicare, have likely contributed to the slowdown in health care spending growth by tightening provider payment rates and introducing incentives to reduce excess costs.
Among these are various provisons that reduced payments to hospitals, other providers, and private Medicare Advantage plans; and there are several incentive programs designed to improve quality and lower costs.

29. High levels of public dissatisfaction with ACA
MYTH

30. High levels of public dissatisfaction with ACA
REALITY
High levels of public dissatisfaction with ACA

31. High levels of public dissatisfaction with ACA
REALITY
High levels of public dissatisfaction with ACA

32. High levels of public dissatisfaction with ACA
REALITY
High levels of public dissatisfaction with ACA

34. Bottom ________________
Generally a positive impact in terms of:
Accessibility
Coverage
Satisfaction
Quality of Care
Employment Impacts

35. Bottom ________________
Not sure:
Costs seem to be rising at least as much as might have been expected.
Some issues in terms of “adverse selection” – those who are unhealthy seem to enroll (when they need care), and then drop (when they’ve received the care). This is not a good thing in the sense of insurance markets.