The ACA’s Success is Bigger Than Enrollment
The end of the first open enrollment period has brought with it some great news – more than 8 million individuals have enrolled in Marketplace plans since October 2013, and more than 4 million individuals gained coverage through Medicaid and CHIP. This number surpassed the expectations of the Congressional Budget Office, the Centers for Medicare and Medicaid Services, and even the White House. It is certainly a reason to celebrate the Affordable Care Act and the way it has increased health care access and coverage options for millions of consumers.
But 8 million new enrollees do not tell the complete success story of the ACA. According to a recently released RAND study, 9.3 million Americans were newly insured between September 2013 and mid-March 2014. In addition, Gallup recently reported that 4 percent of the American population became newly insured in 2014, and about half of these individuals obtained coverage through the marketplaces. Overall, these figures represent a drop in the uninsured population from 20.5 percent to 15.8 percent.
What do these enrollment numbers mean, exactly? For one, they signify that a great portion of the American public desired access to health insurance and got what they wanted. In March and April alone, three times as many consumers signed up for coverage as the White House had expected. Overwhelmingly, uninsured and underinsured consumers want access to quality, affordable coverage. Although comparing and choosing health plans is not an easy process, and was only made more difficult by technical glitches with marketplace websites, consumers persevered. Their perseverance shows that the Affordable Care Act is delivering something many American consumers want.
But the ACA’s success doesn’t stop at increased access. The 8 million individuals who signed up through the Marketplaces not only received new access to coverage, but access to coverage that is more affordable. These consumers will be eligible for premium tax credits and cost-sharing reductions, based on their household size and income, to ensure that the amount they pay for these plans is within their budget.
In addition, the high enrollment numbers represent a major stride made towards reducing poverty and inequality. It is perhaps not surprising that the majority of the newly insured have lower-than-average annual household incomes. As Gallup reported, 38 percent of those newly insured earn less than $24,000 per year, while 75 percent earn less than $60,000 per year. The fact that these consumers can now access care, and also pay for this care based on their income, means that concerns over medical debt or foregoing care can be substantially lessened.
Community Catalyst partners with organizations throughout the country on ACA outreach and enrollment initiatives. One of our partners is Foundation Communities in Austin, Texas, a non-profit that offers health plan enrollment and tax preparation assistance to low-income individuals. Adam’s* story is a compelling illustration of how the ACA is improving the lives of American consumers:
Adam began his career in 2008 as a young, healthy and uninsured musician living in Austin, Texas. Two years later, he was diagnosed with Crohn’s Disease and ulcerative colitis. When his family attempted to buy insurance for Adam, he was denied coverage due to his pre‐existing conditions. However, in January 2014 Adam met with a certified application counselor at Foundation Communities. He and his counselor focused on finding a plan that would cover his prescriptions and include his specialists. After assisting Adam with phone calls to insurance companies and researching coverage options over two visits, he selected a plan that met his specific medical needs, cost $32 a month and had a maximum out‐of‐pocket of $500. Adam told us, “[My doctor and I] have been waiting years for this. The prescription medicine I need costs about $30,000 a year. I’ll be getting this medication for only $500. I can’t believe it.” His first phone call was to his doctor to share the good news.
There are many newly insured people like Adam who are now able to access needed care thanks to the ACA. While enrollment numbers are (rightfully) driving headlines, the ACA goes beyond helping consumers access coverage, the law ensures consumers can buy better coverage and have better information about their coverage. The ACA requires all health plans to cover “essential health benefits,” or 10 categories of care that cover a wide range of important services. By requiring plans to offer services in all of these categories, consumers will be able to receive more comprehensive care. Additionally, having access to a variety of preventive services means consumers will be able to address health issues earlier, before they become more harmful or costly. Consumers will also have access to better information about how their insurer pays for their care. Health plans are now required to disclose how they set premium rates, and must post any increase in premium rates as well as a justification for this increase on their website. They must also disclose the number of claims they have denied and any cost sharing obligations for out-of-network providers.
With new ways to access coverage, more comprehensive coverage, and better tools and transparency to understand this coverage, the ACA is already succeeding at ensuring American consumers can choose a health plan that meets their needs and receive quality, affordable care.
— Rachelle Rubinow, Outreach and Enrollment Intern