Recent testimony to the Senate shows different perspectives on the success and continuing challenges of the Affordable Care Act.

The Commonwealth’s testimony provides a well documented report on the different ways in which the ACA has changed health care delivery in the US. The Commonwealth used Congressional Budget Office figures, usually considered an unbiased source.

Basically, the good news for consumers:

• more people, of all races and ages, are insured
• most of those people are satisfied with their insurance
• less people report being unable to get needed care because of costs…a reflection of lessening financial difficulties due to medical care costs
• people have found paying for insurance easier in the Marketplace (subsidies have gone a long way…and yes, a pending King v Burwell judgment may change all of that)
• the markets themselves have proved quite stable
• states that have not expanded Medicaid (including Kansas) continue to have higher rates of uninsured
• the rate of growth of health care spending has slowed allowing reduction in projected costs
• young adults remaining on parents’ plans is significant

Know that other testimony was not as positive. Small businesses find that they are still struggling to provide insurance, sometimes in a volatile market. (See the testimony from the National Federation of Independent Business.) Note though that since the ACA does not mandate small businesses to provide insurance, many of those workers are able to seek insurance in the Marketplaces.  So while it may impact the small businesses in that being able to provide employer sponsored coverage is a currently a marketing and recruitment tool for the best and most skilled workers, those workers still have options.  It will be interesting to watch how this part of the market responds, especially as the SHOP (Small Business Health Options Programs) becomes more popular. The SHOPs offer businesses under 50 employees a marketplace of their own to find plans at better rates. Those under 25 employees are also eligible for subsidies to assist them in paying for premiums for their employees.

And testimony from the Mr. Holtz-Eakin, President of the American Action Forum,was most negative of all:

“The main promise that we heard repeated over and over again was that the ACA would provide universal access to affordable coverage of high-quality health care. In these remarks I will discuss (1) coverage, (2) affordability, (3) quality, and (4) access to care under the ACA.

The ACA has been riddled with wasted money and broken promises. It has proven to be poor growth policy, red-ink budget policy, flawed insurance policy, and poor health care policy. Instead of growth, it has contributed to a mediocre recovery. Instead of fiscal responsibility, it has exacerbated the red ink that plagues the government. Instead of universal coverage for the uninsured, the retention of valued policies and lower premiums, it has produced spotty, uneven coverage expansions, the forcible loss of valued polices and higher premiums for all. And instead of bending the cost curve and raising quality, it has delivered limited access to doctors and the loss of preferred providers.”

This testimony seems focused more on technical glitches and precise wording of promises, rather than an ability to understand the major successes that have accrued to millions of Americans as noted in the CBO figures and Commonwealth report. Mr. Holtz-Eakin speaks to premium increases without regard to the significant impact the tax subsidies are having on the actual out of pocket costs to consumers of those premiums. He complains that Medicaid is not doing as it had intended, yet it was the Supreme Court’s decision that limited significantly the impact Medicaid expansion could have on decreasing the numbers of uninsured, not the ACA itself. Mr. Holtz-Eakin seems concerned with not having access to preferred providers but those decisions are really within the realm of the insurance plans, and they have been changing those, without any laws, for years. Suffice it to say that I find this testimonial to be mostly emotionally charged, focused on specifics of language, rather than seeing the millions who have been helped by ACA consumer protections (including no exclusions for pre-existing conditions, no annual or lifetime maximums of coverage, no non-issuance of plans, and coverage of preventive service, free at time of service).

There are problems with ACA, as noted by the business community, and there is still a long way to go on reforming the system of health care delivery. But as noted by the Commonwealth testimony:

“ At the five-year mark, there is strong evidence that the Affordable Care Act has resulted in gains in coverage, affordability, and access to health care services. It may also have created the foundation for significant changes to the way we deliver and pay for care. Taken together, a promising picture emerges. Five years, however, is a short time in the life of legislation as ambitious and sweeping as the ACA. Additional studies and evaluations will be necessary to paint a fuller picture of the law’s impact on Americans and their health care system.”