PPACA 'Working as Designed,' Says Commonwealth Fund

Data from the Commonwealth Fund shows that federal healthcare reforms are increasing access to affordable medical services for millions of Americans. But the uninsured rate has not changed since last year.

Access to medical services has widened since the Patient Protection and Affordable Care Act was enacted, but the pace has slowed.

A survey of adults aged 18 to 64 shows positive signs for previously uninsured people who have gained health coverage through insurance exchanges and Medicaid expansion programs established under the PPACA.

The Commonwealth Fund Affordable Care Act Tracking Survey was conducted this year from Feb. 2 to April 5. The survey is based on 15-minute phone interviews with 4,802 adults, 881 of whom had obtained new health coverage through HIX health plans or Medicaid expansion.

During a conference call with members of the media on Tuesday, officials from the Commonwealth Fund highlighted findings of the tracking survey, including gains in healthcare-service access as well as relatively high patient satisfaction with health coverage obtained through HIX health plans and Medicaid expansion.

"These findings show the Affordable Care Act is working as it was designed to do," said David Blumenthal, MD, president of the Commonwealth Fund.

The findings of the tracking survey show the PPACA has generated several positive results for the previously uninsured:

• The uninsured rate for adults aged 18 to 64 has dropped significantly since the launch of the PPACA health insurance exchanges in 2014, falling from 19.9% in the third quarter of 2013 to 12.7% this year.
   
• Nearly half of adults in HIX health plans and three of five adults enrolled in Medicaid were uninsured before they got their health coverage.
   
• More than half of previously uninsured adults had been uninsured for more than two years before getting their new coverage.

The Commonwealth Fund tracking survey also found a significant gain in access to medical services linked to the PPACA health insurance exchanges and Medicaid expansion.

For survey respondents who had health insurance through a HIX health plan, 51% said they could obtain medical services that they could not have accessed and/or afforded before they obtained their new insurance.

For survey respondents who had gained health coverage through Medicaid expansion, 70% said they could obtain medical services that they could not have accessed and/or afforded before.

Hitting a Plateau

While the Commonwealth Fund tracking survey paints a generally bright picture of the PPACA's performance, there are some dark shades in the data:
For adults aged 18 to 64, the uninsured rate for this year is not statistically different from last year.

• For adults with incomes below 138% of the federal poverty level, gains in uninsured rates have leveled off since 2014. "Many remain uninsured, especially those with low incomes," Sara Collins, the lead author of the tracking survey, said during Tuesday's conference call.
   
• Although HIX health plan enrollees reported satisfaction with their health coverage on par with people insured through their employers, Collins said they may look for new coverage HIX insurance rates spike next year. "People were most satisfied with their choice of doctor and hospital. They were less satisfied with the cost of their plans," she said.

The data released Tuesday is from the fourth in a series of Commonwealth Fund surveys designed to gauge the impact of the PPACA. The first was conducted in 2013.