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January 3, 2014

Four ways to tell if Affordable Care Act is working

WASHINGTON — We are now days into the health-care law's insurance expansion, which began at midnight on Jan. 1. And it is, alas, far too early to tell if the nation's new health-care reform is working. We know that no "death panels" have materialized but, aside from that, have very little information about how the Affordable Care Act's newly insured are changing our health-care system.

It is not too early though to think a bit about what "working" actually means. There are a handful of ways that we tend to measure the success of health insurance expansions in the United States. The Patient Protection and Affordable Care Act (ACA) is no exception here; it's a complex law where there are at least four policy outcomes that all count as some definition of "working."

Do more people have health insurance?

One key goal of the health law was to reduce the uninsured rate by making it easier for the 48 million Americans without insurance coverage to get it. The Congressional Budget Office projects that about 30 million people will gain coverage over the next decade, compared to a scenario where the ACA had never passed. That will be one yardstick by which to tell if the health-care law is working: Whether more people have coverage.

This is actually difficult to measure, at least in the short-term, because there's no national clearinghouse of people who do or don't have insurance. The combination of insurance cancellations and exchange sign-ups make it really hard to know, at this very moment, whether the health law has led to a net gain in coverage. The Census Bureau does do annual surveys on insured rates, but those come out on a bit of a delay. The federal agency won't publish data on 2014, for example, until the fall of 2015.

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