Internist Douglas Olson has seen firsthand the impact—and
the side effects—of the Affordable Care Act’s first year of expanded
health-care coverage. One patient at his clinic had lost her previous insurance
after being diagnosed with lung cancer. This year, she was able to find an
affordable policy that covered her treatments and follow-up scans.
Dr. Olson’s patients illustrate the trade-offs and lessons
in the sweeping federal health law. Overall, 6.7 million Americans have
obtained and paid for private coverage on the insurance marketplaces for this year,
according to federal officials. Almost 10 million more qualified for Medicaid
due to provisions in the law. And the percentage of uninsured dropped from
17.7% to an estimated 12.4%, according to the Urban Institute.
In the second yearly enrollment, almost 6.4 million people
selected a health-care plan on the federal marketplace or were automatically
re-enrolled between Nov. 15 and Dec. 19, Health and Human Services Secretary
Sylvia Mathews Burwell said Tuesday. The figures include about 1.9 million new
consumers but don’t include enrollees from state-run exchanges. Enrollment on
the federal exchange runs through Feb. 15.
How the Affordable Care Act has helped—and what it has
cost—consumers, employers and care providers varies enormously. Some people with
life-threatening illnesses found coverage. Some hospitals and doctors are
seeing more patients with the ability to pay. But many families and businesses
are facing higher costs. There is still confusion over how the new plans work
and a palpable disconnect between near-term expenses and long-term
public-health goals.
The public remains deeply divided. As of last month, more
Americans viewed the law unfavorably (46%) than favorably (37%)—a shift from
four years earlier, when respondents favored it 42% to 40%, according to a
Kaiser Family Foundation poll.
A Wall Street Journal project following 10 stories of people
affected by the health law over the year shows the wide range of experiences. Nationwide,
the median deductible for individuals was $5,100 in bronze plans and $2,500 in
silver plans, according to a McKinsey & Co. analysis. To be sure, insured
patients can get preventive care, including vaccinations and screenings for
cancer, without any deductibles or copays under the law. But that has been a
hard sell for some patients.
All in all, Dr. Olson said he and his colleagues think even
harder whether costly tests and procedures are necessary than they did before
the ACA. Some economists say the impact of high-deductible plans, prominent in
employer-sponsored coverage as well, was a key driver in holding the growth of
health-care costs to 3.6% in 2013—the lowest since the government started
measuring it in 1960.
Government actuaries expect to see a spurt in national
health spending—rising by 5.6% in 2014, due to the ACA’s coverage expansion,
and reaching 19.3% of GDP by 2023.
Some hospitals have already seen windfalls, with more paying
patients boosting revenues. The impact on insurers has also been mixed.
For actuary Mike Beuoy and his employer, Blue Shield of California, offering
plans on the state’s marketplace turned out to be a good bet. The nonprofit
made money because more people signed up than expected, and they were healthier
than it projected when it set 2014 rates.
Several big companies warned they will post losses on their
individual business. But for now, the industry seems willing to double down on
the exchanges, with some companies, including giant UnitedHealth Group Inc.,
boosting their presence next year.
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