Sarah Kliff: Four ways to tell if Obamacare is working

01/06/2014 5:25 PM

01/06/2014 5:25 PM

We are a few 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:

•  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 with a scenario in which the ACA had never passed. This is actually difficult to measure, at least in the short term. 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.

•  Do Americans have better access to health care?

Another metric to measure the ACA is whether Americans have an easier time seeing the doctor or meeting their medical needs without financial hardship. This is true both for those gaining coverage under the health law and for those who already have it. One metric that really interested researchers comes from Massachusetts, where they can measure what happened to those who already had coverage when many more people gained access to it. They can look at this by researching wait times to see doctors and surveying the general population about whether they can afford the care they need more easily. A much-watched study of Medicaid expansion in Oregon – where coverage was assigned randomly, by lottery – was one example in which researchers showed a reduction in financial hardships when Oregonians enrolled in the public program.

•  Are Americans getting healthier?

Proving a link between health insurance coverage and health status improvement can be challenging. Trips to the doctor are, obviously, only one factor among dozens that contribute to an individual’s physical well-being. That same study of the Oregon Medicaid expansion showed a 30 percent reduction in depression rates, but found no short-term impact on physical health measures, such as cholesterol and blood pressure.

•  Is health care becoming more affordable?

The health care law contains dozens of experiments, mostly in Medicare, meant to encourage lower spending on health care without cutting into quality. The Obama administration is also optimistic that the new insurance exchanges will drive down the cost of premiums, by putting all insurers into a regulated marketplace.

There are a few ways to measure affordability, one being the country’s overall tab for health spending, and watching how quickly – or slowly – it grows. (Right now, health care costs’ growth is at a historic low.) You can also survey Americans directly, about whether they feel it’s easier to afford health care. Perhaps surprisingly, these two metrics don’t always add up: Even with health costs’ growth slowing dramatically, public survey research shows Americans feel even more pinched when it comes to their health bills.

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