The Affordable Care Act (ACA) turns six this Wednesday, March 23. The young health care reform law has achieved some impressive accomplishments, especially since a couple of key parts of the law took effect in 2014. Nevertheless, public opinion about the law is divided, and many Republican politicians are intent upon repealing the ACA.

The fate of the ACA is sure to be a major topic of debate during the fall election campaigns. As candidates debate the law in the months ahead, let’s keep in mind the law’s achievements and ask the proponents of repeal how they would improve upon the following accomplishments.

There have been huge gains in health insurance coverage:

• The Dept. of Health and Human Services (HHS) estimates that there has been a net reduction of 20.0 million uninsured adults over the past six years (primarily since January 2014), and a 43% drop in the uninsured rate for non-elderly adults since the fall of 2013.  (Read more here.)
• In Wisconsin, ­­more than 239,000 people signed up for or were automatically re-enrolled in health plans through the federal Marketplace during the recently-concluded open enrollment period, and about 84% of them are eligible for subsidies that help make coverage affordable. (Read more in this recent blog post.)
• Census Bureau data show that about 100,000 fewer Wisconsinites were uninsured in Wisconsin in 2014 (a 19% drop in one year), and the Marketplace enrollment figures suggest that there have been significant gains in coverage since then.  (See this Sept. 2015 blog post.)

Gains in coverage have been strong across all racial and ethnic groups – According to a recent analysis:

• The uninsured rate among Black adults has dropped by about 53% since the fall of 2013, corresponding to about 3 million adults gaining coverage.
• The portion of Hispanic adults who are uninsured dropped by 27%, amounting to about 4 million more Hispanics who now have insurance.
• The uninsured rate among White non-Hispanic adults declined by about 51%, as about 8.9 million gained coverage.

Access to preventive care has improved

Research has shown that access to evidence-based preventive services improves health and saves lives by identifying illnesses earlier. The ACA has made access to important preventive care services a priority and implemented provisions to remove barriers to access, such as cost.  Private health plans are required to cover a number of preventive care services for adults and children without any cost-sharing.

• HHS estimated in 2014 that the ACA made nearly 76 million Americans newly eligible for free preventive care. (Read more here.)

Hospitals’ uncompensated care costs are much lower

• The cost of uncompensated care provided by hospitals fell by an estimated $7.4 billion (21%) in 2014, according to an HHS analysis. That helps avoid cost shifting to other health care consumers.
• In Wisconsin, uncompensated care fell by $42 million (15.3%) in 2014, compared to 2013, according to data from the WI Hospital Association). The smaller improvement in Wisconsin (compared to the 21% decline nationally), can probably be attributed to the fact that state lawmakers only partially expanded Medicaid coverage of childless adults and reduced eligibility for parents.

Seniors are saving on prescription drugs costs

Since the inception of Medicare prescription drug plans in 2006, there has been a coverage gap known as the “donut hole,” which has been costly for many seniors. After a Medicare prescription plan paid a certain amount for covered drugs, the senior would have to pay the full costs until their spending reached another threshold and their insurance coverage resumed.

• The ACA is slowly reducing the “donut hole” until it is eliminated in 2020, and HHS estimated that in the first five years after enactment of the ACA, 9.4 million seniors and people with disabilities saved over $15 billion on prescription drugs, an average of $1,598 per beneficiary.
• The savings are now well over $5 billion per year and will grow much larger until the ACA completely closes the “donut hole” in Medicare drug plans.

This isn’t a complete list of the law’s accomplishments, and I haven’t attempted to itemize its shortcomings.  As the campaign season proceeds, we will certainly hear more about the latter, and we should carefully explore the merits of the complaints about the law.

Considering that millions of Americans are now insured because of the ACA, and millions of others have benefitted from the law in other ways, opponents of the law need to do more than simply cite the law’s shortcomings. It’s time for proponents of repeal to explain how they will implement more effective alternatives for improving the health care system without undoing the very substantial gains in access to insurance  and preventive care that have been achieved over the last several years.

The ACA isn’t perfect, and I certainly hope that Congress and the next president will objectively review the data that sheds light on the law’s strengths and weaknesses. I also hope they will work together next year to ensure that we keep moving toward, not away from, the goal of improving access to quality, affordable health care.

Jon Peacock