10th Anniversary of the ACA: A Time to Reflect on its Impact and Refocus Efforts on the Act’s Purpose and Goals
COVID-19 has shown how important it is to fully fund the ACA created Prevention and Public Health Fund
March 23, 2020
This tenth anniversary of the enactment of the Affordable Care Act (ACA) is an appropriate time to measure its impact and recommit to its purpose. Prior to the ACA, more than 44 million non-elderly adults were uninsured. By 2016, that rate of uninsured people reached a historic low as approximately 20 million Americans gained access to health insurance coverage under the ACA including 12 million adults who gained coverage due to Medicaid expansion.[1]
The ACA was transformative legislation in at least three ways. It offered Americans access to medical care when they were acutely ill and when they needed ongoing treatment for a chronic condition (78 percent of U.S. adults 55 and older have at least one chronic condition[2]). In addition, millions of Americans gained access to preventive care such as vaccinations and health screenings. Thirdly, it helped advance health equity by narrowing – although not eliminating – the gaps in access to high-quality care experienced by people of color due to economic disadvantage and systemic discrimination.
Prior to the ACA, Black Americans were 70 percent more likely to be uninsured than Whites and the uninsured rate for Latinos was nearly three times the uninsured rate for Whites[3]. After the ACA became law, Latinos had the largest decrease in uninsurance rates, falling from 32.6 percent to 19.1 percent between 2010 and 2016. Uninsurance rates also fell by 8 percent for Asian Americans and Black Americans during the same period.[4]
Medicaid expansion states experienced significant coverage gains and reductions in uninsured rates among low-income individuals and within specific vulnerable populations.[5] A study by the National Bureau of Economic Research found that Medicaid expansion is associated with reduced mortality.[6] According to the study, states that expanded Medicaid had an estimated 19,200 fewer adult deaths (ages 55 to 64) between 2014 and 2017 than did states that did not expand Medicaid.[7]
Furthermore, the ACA created the Prevention and Public Health Fund (PPHF) and allocated $2 billion annually as an “expanded and sustained national investment in prevention and public health programs”. Unfortunately, much of the PPHF funding has been reallocated to other programs outside prevention and public health. On this 10th anniversary of the passage of the ACA, Congress should redouble its efforts to ensure the Prevention Fund is fully funded and that those funds are directed as intended, to prevention and public health programs.
As the COVID-19 pandemic has put in the spotlight, individual health is often linked to community health. The Prevention and Public Health Fund’s intended purpose and emphasis: sustained investment in the nation’s public health infrastructure would, if fully realized, strengthen our national readiness for health emergencies. A level of readiness that the COVID-19 pandemic has shown to be seriously inadequate.
While this 10th anniversary of the Affordable Care Act is a time to recognize and applaud its significant impact, it is also a time to shine a spotlight on the fact that over 27 million Americans remain without access to healthcare due to being uninsured. Ensuring that all Americans have access to healthcare is a priority of Trust for America’s Health and must be a national priority.
[1] Garfield R, Orgera K, Damico A. The uninsured and the ACA: a primer—key facts about health insurance and the uninsured amidst changes to the Affordable Care Act [Internet]. San Francisco (CA): Henry J. Kaiser Family Foundation; 2019 Jan 25. https://www.kff.org/uninsured/report/the-uninsured-and-the-aca-a-primer-key-facts-about-health-insurance-and-the-uninsured-amidst-changes-to-the-affordable-care-act/ Google Scholar
[2] CDC, National Center for Health Statistics. Percentage of U.S. Adults over 55 with Chronic Conditions. https://www.cdc.gov/nchs/health_policy/adult_chronic_conditions.htm
[3] Buchmueller TC, Levinson ZM, Levy HG, Wolfe BL. Effect of the Affordable Care Act on racial and ethnic disparities in health insurance coverage. Am J Public Health. 2016;106(8):1416–21
[4] Garfield R, Orgera K, Damico A. The uninsured and the ACA: a primer—key facts about health insurance and the uninsured amidst changes to the Affordable Care Act [Internet]. San Francisco (CA): Henry J. Kaiser Family Foundation; 2019 Jan 25. https://www.kff.org/uninsured/report/the-uninsured-and-the-aca-a-primer-key-facts-about-health-insurance-and-the-uninsured-amidst-changes-to-the-affordable-care-act/
[5] Madeline Guth, et al. The Effects of Medicaid Expansion Under the ACA: Updated Findings from a Literature Review. March 17, 2020.
[6] Sarah Miller et al., “Medicaid and Mortality: New Evidence from Linked Survey and Administrative Data,” National Bureau of Economic Research working paper, August 2019, https://www.nber.org/papers/w26081.
[7] Ibid
