This paper discusses the impact of the Affordable Care Act (ACA) on the United States. First there is discussion regarding what led up to health care reform followed by the impacts of the bill and the current trends.
One motivation was that the "US system left more than 1 in 7 Americans without health insurance coverage in 2008." Also, there was an upward trend in how much the economy was spending on healthcare.
The first results are shown in Figure 1. The number of uninsured dropped after the ACA. Maybe this is the most significant take away but it doesn't capture the quality and cost of care which are also addressed in the paper.
The paper states "Before the ACA, the health care system was dominated by 'fee-for-service' payment systems, which often penalized health care organizations and health care professionals who find ways to deliver care more efficiently, while failing to reward those who improve the quality of care. The ACA has changed the health care payment system in several important ways."
The ACA modified payments for medicare services and introduced a "value-based payment" system with the goal of reducing overall cost. This is shown in Figure 4. What the plot is showing is the change over a time period. Between 2000-2005 the costs per payer were increasing in all programs. Between 2005-2010 medicaid cost to the person was decreasing and the other programs were still growing but growing slower. Between 2010-2014 the cost to both medicare and medicaid are both in decline. Private insurance costs are still increasing but they are increasing slower than before.
Another interesting take away is that "[t]he rate of hospital-acquired conditions (such as adverse drug events, infections, and pressure ulcers) has declined by 17%." This is reflected in the 30-day readmission rates dropping shown in Figure 6.
