Fourteen years ago, the Affordable Care Act (ACA), also known as ObamaCare, became law. 

Today is National Doctor’s Day. Everyone loves the icebreaker game “Two Truths and a Lie.” Can you guess which of the following is NOT true about the ACA?

A. The ACA resulted in a dramatic increase in the number of people with health insurance, mostly by expanding private health insurance. 

B. The ACA caused health insurance premiums and deductibles in the individual market to skyrocket.

C. The ACA caused health insurance plans to narrow their networks, in other words, to restrict which hospitals and providers were available to people with ACA coverage. 

A. LIE! While the ACA did dramatically increase the number of people with health coverage, it primarily did so by expanding the Medicaid program. A paper from the Galen Institute makes this abundantly clear. Here are a few facts from the paper:

  • The Congressional Budget Office overestimated the number of people who would enroll in private ACA coverage by about 17 million.
  • Medicaid expansion, by contrast, enrolled far more people than expected. Medicaid has a “crowd out” rate of about 60%, meaning for every 10 people who enroll, six people left private coverage to do so. 
  • The Medicaid expansion did not result in improved health outcomes for those enrolled but did increase emergency department use. 
  • Medicaid expansion represents a huge subsidy that mostly benefits hospitals, not people in poverty or at the brink of poverty.

B. TRUTH! One ironic result of the “Affordable Care Act” is how unaffordable health insurance became as a result of its stringent regulations. The ACA dictates what every compliant insurance plan must cover and how plans can be priced and sold. These many mandates significantly increased the cost of health insurance, causing hardship for many. 

  • Premiums increased by 105% in the law’s first four years of implementation (2013-2017).
  • Deductibles in ACA plans (on the exchanges) are now about three times higher than in employer plans. Bronze plans have deductibles of more than $6,000 for individuals and $12,000 for families. For silver plans, those numbers are about $3,500 and $7,500. Most people don’t have that kind of money lying around. 

C. TRUTH! There’s an important difference between health insurance coverage and health care. Having the former doesn’t guarantee the latter. Imagine having a coupon for a free TV, but no retailers in your area have any TVs available in their stores. 

  • 72% of ACA plans feature narrow networks. 
  • Not a single ACA plan in Texas offers coverage at MD Anderson Cancer Center in Houston, a world-renowned cancer hospital.
  • ACA plans have 42% fewer cancer and cardiac specialists in-network compared to employer coverage. How does that serve patients with pre-existing conditions like cancer or heart disease?

For more information or citations for these facts above, check out the full “ACA at 10” paper from the Galen Institute. 

Bottom line: The ACA has not lived up to its promises in many ways. Of course, its intentions were good. The healthcare system before the ACA was far from perfect. It was and is problematic that we have an employer-centric insurance system in the U.S. today. And it was and is problematic that patients lack transparency, choice, and control over their health care and healthcare dollars. Reform was—and twelve years later, still is!—needed.