Five years ago, on March 23, 2010, President Barack Obama signed the Affordable Care Act (ACA) into law. This historic signing marked a national effort to increase the affordability of health insurance, lower the uninsured rate, reduce the costs of health care, and increase the quality of care provided.
On March 20, 2015, a panel of key Pennsylvania-based health care organizations took a closer look at the ACA five years later and what we have learned.
Panelists for the media call-in included Andy Carter, president and chief executive officer at the Hospital & Healthsystem Association of Pennsylvania (HAP); Cheri Rinehart, president and chief executive officer of the Pennsylvania Association of Community Health Centers (PACHC); Erin Ninehouser, education and outreach director at the Pennsylvania Health Access Network (PHAN); Deborah Shoemaker, executive director and lobbyist for the Pennsylvania Psychiatric Society (PaPS); and Dennis Olmstead, chief strategy officer and medical economist at the Pennsylvania Medical Society (PAMED). Michael Fraser, PhD, CAE, PAMED’s executive vice president, served as the moderator of the call.
Mr. Carter, HAP president and CEO, talked about several major health care trends, including a decrease in health care spending and an increase in quality of care. Before the ACA, he said, the economy was seeing an annual growth rate of somewhere between 8 and 9 percent a year in total health care spending. After the ACA, for several years in a row, that number has been between 3 and 4 percent, which is definitely something to celebrate, he said.
He also cited statistics which show an increase in the quality of care since the ACA was signed into law, including a 37 percent reduction in conditions, errors, and/or infections that happen in hospital settings, and a 26 percent decrease in hospital readmissions within the first 30 days.
Carter referred to the hospital world before the ACA as more of an inpatient centric system, with so much health care being provided within the four walls of hospital health care settings. But, he said, there has been a significant shift to more community-based and outpatient care. He cited that, since 2000, there has been a 10 percent drop in patient admissions to hospitals.
He also said that there is evidence of a major shift, thanks to the ACA, in the extent to which consumers pay closer attention to the quality of care that they receive as well as the cost of care.
Ms. Rinehart, president and CEO of PACHC, said one of the overriding goals of the ACA was to swing the pendulum more toward primary and preventive care, and increase consumer engagement and a sense of personal responsibility to control health care costs.
She said among what we have learned is that insurance doesn’t equal access, enrollment assistance is important, and coordinated, integrated care, like that delivered in community health centers, produces the best outcomes.
She also said some of the lessons are a result of demonstration projects and new initiatives that have encouraged new partnerships and new conversations, such as Accountable Care Organizations (ACOs), and the drive toward patient-centered medical homes (PCMHs), to produce better coordinated care, and make sure that patients are truly at the center of their care.
Ms. Ninehouser, education and outreach director at PHAN, said the ACA really set out to repair the biggest cracks in the foundation of our nation’s health care system. After five years of the health care law and two years of open enrollment, it’s very clear that it’s working, she said. She said PHAN has connected nearly 3,000 patients with health insurance and educated approximately 42,000 people about new options under the ACA. She also said it has enrolled as many people in the first few months in 2015 as it did in all of 2014.
Prior to the ACA, she said, there were 1.2 million people who were uninsured, and that number has been cut in half. She also said that, after the most recent enrollment period, approximately 472,697 Pennsylvanians are now covered through private insurance plans purchased at healthcare.gov, many of whom were able to get financial assistance. Nationally, 16 million Americans have gained access to insurance under the ACA, she said.
Ms. Shoemaker said that, as an organization representing physicians who practice in the areas of mental health, substance use, and intellectual and developmental disabilities, PaPS has been really excited about activities that have evolved since the implementation of the ACA. One of the most exciting things, she said, is that there has been a much bigger focus on the integration of behavioral and physical health.
For too long, she said, there have been silos between insurers, treatment providers, and the overall health care system when individuals are in need of both physical and behavioral health treatment and services. She went on to say that there are a lot of opportunities for integration at the state and national level. PaPS looks forward to ACA and Medicaid expansion in Pennsylvania and will continue to advocate for positive change and work with stakeholders as the process evolves and moves forward.
Dennis Olmstead, chief strategy officer and medical economist at PAMED, said that the first principle in PAMED’s eight essential principles of health system reform, which PAMED adopted in October 2009, is that health care coverage should be both available and affordable to all American citizens and legal residents.
The ACA has had a positive impact in many ways, he said, citing several results from the recent Pennsylvania Patient poll. Among them are that, of the 700 Pennsylvanians surveyed, 75 percent said they could get an appointment within a week or less, 51 percent in less than three days.
He also said that, even though there have been improvements since the ACA, we cannot take our eye off the ball, especially as Pennsylvania does poorly in retaining residents and medical students. He said PAMED is working with the Joint State Government Commission to analyze physician shortage issues and recommend solutions.
What questions remain unanswered for Pennsylvania physicians since the ACA became law five years ago? Watch this video to see what Mr. Olmstead says.