President Obama reflects on the Affordable Care Act

1. In this special communication, President Obama discusses the many ways in which the Affordable Care Act (ACA) has affected healthcare in the United States.

2. This review specifically highlights how the ACA has led to lower rates of uninsured individuals, changes in medical payments in part through Accountable Care Organizations (ACOs), and other societal benefits.

Evidence Rating: 5 (Poor)

Study Rundown: Since it was signed into law on March 23, 2010, the ACA has led to dramatic changes in the delivery of healthcare in the United States. In a special communication to the Journal of the American Medical Association (JAMA), President Barack Obama reflects on the historical changes afforded by the bill, and presages the future work that will be required to further improve the health of all Americans. The primary aim of the ACA was to expand healthcare coverage to a wide swath of the uninsured. Since becoming law, the number of uninsured has fallen 43%, from nearly 49 million in 2010 to approximately 29 million in 2015. The rate of uninsured has fallen across the country, but has done so most readily in those states that have participated in the Medicaid expansion.

While successful in its primary goal, President Obama also reviewed how the ACA has addressed the so called “triple aim” of medicine – providing better care at lower costs to improve the public’s health. The article shows that the growth rate of medical care has decreased over time; it also notes that external factors, like the recession of 2008, also likely had some effect. In terms of quality, avoidable medical harm, like infections and readmissions have also declined sharply since 2010. Overall, more Americans are able to access care, and by focusing on innovative new delivery methods, like ACOs, President Obama posits that incentives are in place to continue this drive towards improving public health.

As with all opinion pieces, clear bias and a selection of only particular data is apparent in this article. For instance, while President Obama notes that healthcare spending has slowed, a thorough review of the literature shows that many factors, including the reduced used of certain technological advancements, have likely played outsized roles. Regardless, the ACA has transformed American healthcare, and this article shares President Obama’s unique perspective at the center of this process.

Click to read the study, published in JAMA

Relevant Reading: The past and future of the Affordable Care Act

In-Depth [expert opinion]: President Obama’s special communication relies on an appraisal of data from several distinct sources. In order to assess how the rates of uninsured have changed over the time, publicly available administrative data and surveys were reviewed. This analysis showed that, between 2010, when the ACA was passed, and 2015, the rate of uninsured fell from 16.0% to 9.1%. In real terms, the number of uninsured Americans fell from approximately 49 million to 29 million.

The article also reviewed changes in the cost of aggregate healthcare in the US by assessing publicly available government estimates and projections, as well as previously published data and analyses. While the article cites other external causative factors, it shows that the growth rate of healthcare spending has declined recently. Per capita Medicare expenditures decreased by about 1% annually between 2010 and 2014, while it had previously been increasing by as much as 4.7% per year between 2000 and 2005. Likewise, private per capita expenditures increased by only 1.1% per year between 2010 and 2014, a decrease from a 6.5% growth rate from 2000 to 2005. Finally, the article also analyzes access and quality of healthcare by utilizing number of surveys and administrative data. For example, the study describes that the number of adults unable to afford care fell by 5.5% since 2010, while the rate of hospital readmissions (a crude measure of quality) fell by almost 2%.

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