The law appropriated $11 billion over five years to build and operate community health centers, a major factor in increasing the annual number of patients served to 21 million, a rise of 3 million from previous levels. Some $5 billion has been put into a reinsurance program that has encouraged employers to retain coverage for retirees and their families; 19 million people benefited with reduced premiums or cost-sharing.

SAVING CONSUMERS MONEY Private insurers are required by the law to spend at least 80 to 85 percent of their premium revenues on medical claims or quality improvements, or they must pay a rebate to consumers. In 2012, insurers had to pay $1.1 billion in rebates, an average of $151 per family. Although Republicans contend the law will drive up insurance premiums, thus far it seems to have reduced them. Any insurer that wants to increase its premiums by 10 percent or more for people who buy their own policies must justify the increase to state or federal officials. As a result, the proportion of rate filings that sought increases of 10 percent or more fell from 75 percent in 2010 to 34 percent in 2012, and it is expected to be even lower this year. The average premium increase in 2012 was 30 percent lower than in 2010.

The law also provides for prescription drug discounts to Medicare beneficiaries. More than 6.3 million older or disabled people have already saved more than $6.1 billion on prescription drugs since 2010 and will save even more as a gap in coverage, known as the doughnut hole, is filled in by 2020. And the law ended lifetime dollar limits on services covered by private plans, a matter of great importance to people with very high medical costs. Annual limits on what plans will pay are being phased out.

REINING IN HEALTH CARE COSTS Sharp declines in the annual growth rate in overall health care spending and in Medicare’s cost per beneficiary have eased the pressure on federal budgets and on private insurance premiums. The main factor was presumably the recession, which made people reluctant to spend on health care, but it is possible that the focus on reform has led many providers to act more frugally. The law has reduced unjustified overpayments to private Medicare Advantage plans, which enroll more than a fifth of all beneficiaries, and despite fears to the contrary, Medicare Advantage premiums have fallen by 10 percent and enrollment has risen by 28 percent since the law was passed.

BETTER QUALITY OF CARE One of the most promising aspects of the health reform act is its focus on improving quality. The percentage of Medicare patients requiring readmission to the hospital within 30 days of discharge dropped from an average of 19 percent over the past five years to 17.8 percent in the last half of 2012, an improvement due in large part to penalties imposed by Medicare for poor performance and financial incentives paid by Medicare to providers to encourage better coordination of care after a patient leaves the hospital.