Sometimes, numbers do tell a story. The ACA has no shortage of them, and amid the densely packed provisions, regulations, pilots, demonstrations, fines, and other elements, a few numbers provide a glimpse of the intense wrangling that created both winners and losers in the healthcare reform effort.
One of the biggest numbers is also the mostly hotly contested: whether the ACA will blow a hole in the nation’s deficit or lead to a trillion dollars or more in savings over the first two decades. In March 2010, the Congressional Budget Office predicted the latter, with savings of $143 billion through 2019 and a hazier guess of savings equivalent to 0.5% of gross domestic product through the 2020s (equal to $1 trillion or more).3
The problem? “That calculation reflects an assumption that the provisions of the legislation are enacted and remain unchanged throughout the next two decades, which is often not the case for major legislation,” the CBO wrote at the time. That prediction, at least, was spot on.
Amid the ongoing political back and forth, one point is often overlooked: although still unsustainably high, per-capita healthcare spending is now increasing at the lowest rate in decades. Robert Berenson, MD, an institute fellow at the Washington, D.C.–based Urban Institute, a nonpartisan think tank focused on social and economic policy, notes that the trend (starting in 2006) predated the recession. Likewise, it is occurring in Medicare, where most beneficiaries have first-dollar coverage. Instead of being a side effect of the sluggish economy, Dr. Berenson believes fundamental change is occurring on the provider side, and that the additional focus on reform may be making a difference.
Some analysts, he says, believe that providers are responding to the anticipation of change in the system, and therefore are beginning to change their own behavior accordingly. “That means we have more time to get it right, in terms of wholesale change in how healthcare is delivered, and for me, that’s a good thing,” he says.
A few other numbers of note:
The state- and federal-run healthcare exchanges are expected to cost $1.075 trillion through 2023, according to the CBO. That eye-popping number includes spending for high-risk pools, premium review activities, loans to consumer-operated and -oriented plans, and grants to states for the establishment of exchanges.
The big question, of course, is whether that investment will pay off, and a large part of the answer will rest with a well-balanced risk pool. In other words, long-term financial stability means getting as many young and healthy people into the exchanges as possible.
The ACA sought to increase competition by supporting the creation of consumer co-ops, despite opposition from the insurance industry. By the end of last year, the Department of Health and Human Services had doled out roughly $2 billion in loans to nonprofit co-ops in 23 states as part of its Consumer Operated and Oriented Plan (CO-OP). Backers of these co-ops had initially sought $10 billion, however, based on estimates of what would be required to ensure a higher likelihood of success.