In The Arena The Affordable Care Act Is Working

Phil Schiliro was director of White House legislative affairs and a special adviser to the president from 2009-2012. He recently rejoined the White House as a health-care adviser.

It is now four years since the Affordable Care Act was enacted. And in more than 30 years in government, I’ve never seen a law get so little recognition for doing so much good so quickly.

The right measure of the ACA isn’t whether it avoids political controversy; it’s whether it makes America better by achieving its five most fundamental goals: expanding health-insurance coverage, lowering costs and promoting fiscal responsibility, increasing quality through innovation, protecting seniors and delivering peace of mind to American families by guaranteeing essential rights in dealing with insurance companies.


By that standard the law is already a success. Health insurance has expanded. More than 5 million Americans have signed up for coverage through federal and state marketplaces; millions have been determined eligible for Medicaid or the Children’s Health Insurance Program; and 3 million young adults gained insurance through their parents’ coverage. Even more compelling than statistics are the letters hard-working Americans are sharing with the president. Their unscripted and private testimonials are building a lasting record of the life-changing—and often lifesaving—impacts the ACA is having. One woman from Colorado shared what the peace of mind of having coverage meant to her. “After using my new insurance for the first time, you probably heard my sigh of relief from the White House,” she wrote to President Obama. “I felt like a human being again. I felt that I had value.”

At the same time, costs are coming down. The Congressional Budget Office found the health care law is making significant contributions to fiscal responsibility. The CBO’s most recent estimates show that repealing the law would actually increase deficits by $1.7 trillion over the next 20 years. Moreover, average premiums for coverage through the marketplaces are about 15 percent lower than the CBO previously projected.

There’s more good news when it comes to health care and Medicare spending. The rate of increase in real health spending per person is at its lowest point in 50 years and more than 3 percentage points under the historical average, according to recent data. Growth in the average cost of care for a person enrolled in Medicare is also at unusually low levels, and if that success is maintained, it will translate into trillions in savings over the decades to come. Those savings can be used to pay down our deficit or invest in infrastructure, education, innovation and other key national priorities.

Just three months after the law was signed, House Republicans sounded a warning on jobs and released a report claiming the ACA was “making it harder to put people back to work. By signing ObamaCare into law, President Obama effectively signed pink slips for millions of American workers who will lose their jobs or be denied new jobs.”

That’s not what the facts say. In the 10 years before the law was passed, 3.6 million private-sector jobs were lost. Since its passage, more than 8.5 million private sector jobs have been created. The ACA didn’t create all those jobs, but Republicans’ hyperbolic alarm has been proven blatantly false.

The law’s third goal—to increase quality through innovation—is showing extraordinary promise. Accountable Care Organizations (ACOs)—groups of doctors, hospitals and other health-care providers, who come together to give coordinated care that emphasizes quality, not volume to their Medicare patients—are growing across the country. More than 360 ACOs have been created since the law passed and are saving taxpayers and the Medicare trust fund millions of dollars.

Just as striking is the unprecedented decline in hospital readmissions for Medicare patients. Each Medicare admission costs about $12,000 on average, and each unnecessary trip back to the hospital for a senior is risky and expensive. For years, hospital readmissions rates held steady. But thanks to new incentives in the ACA and other administration initiatives, readmission rates have fallen sharply, corresponding to 130,000 fewer readmissions since January 2012. There’s no better example of the law’s focus on improving quality, helping patients and lowering costs all at the same time.

The law’s overall benefits to seniors are almost hard to believe. Just by phasing out the infamous “donut hole” created in the 2003 prescription drug law, the ACA has saved almost 8 million seniors nearly $10 billion.On top of that, real growth in Medicare spending per beneficiary has averaged virtually zero since 2010—that means lower premiums and out-of-pocket costs for our parents and grandparents. And, since the law’s passage, actuaries have extended the life of the Medicare trust fund by almost 10 years.

Under the ACA, Medicare Advantage, a program through which private insurers provide coverage to Medicare beneficiaries, has remained strong. Since the law passed, average Medicare Advantage premiums are down by more than 9 percent, enrollment in plans has increased by 38 percent and the quality of plans has steadily gotten better.

Finally, the law’s peace-of-mind guarantees—the fifth goal—are now reality. Women can no longer be charged higher premiums just because they are women; workers with physically demanding jobs no longer get charged more because they work hard; more than 120 million Americans with pre-existing conditions can no longer be denied coverage; and lifetime health benefit caps have been lifted for more than 100 million Americans.

The ACA is working. Millions of Americans are gaining coverage. Costs are coming down. Quality is improving and basic rights are being restored to American families. Seniors are benefitting, with billions of dollars in savings. And, on top of that, the law is cutting the federal deficit.

But the law’s opponents refuse to acknowledge any of this and instead seem to cynically hope they can make the reforms poisonous. That won’t work, because facts matter.

The ACA’s overall record is remarkable both in accomplishment and obscurity. It’s hiding in plain sight. But it’s already joining other landmark laws—Social Security, Medicare, Civil Rights and the Clean Air Act—in making America better. And in the months and years to come, that will become clearer and matter more than inevitable challenges of implementation or any of the specious political attacks that get so much attention now.