A researcher at the University of Indiana and her colleagues recently reported that the Affordable Care Act (ACA) Medicaid expansion program may have given low-income childless adults in the states that took expansion money one extra healthy work day per month.
Of course, that’s just one study. Another study might show something else.
But I think the results illustrate why analyzing how wonderful or terrible ACA is happens to be complicated.
Some people will look at high ACA public exchange enrollment figures and cheer at ACA’s success. Or, they’ll look at insurers’ lousy financial results in the individual commercial health insurance market and laugh at ACA’s failure.
Problems with the finances of specific ACA components are interesting but not necessarily definitive.
If health insurers are suffering huge losses because of chaotic federal ACA program administration, that’s a serious concern.
If health insurers are suffering losses mainly because they happen to be covering more sick people and poor people, that raises some questions:
- What kind of care would the newly covered people have gotten before?
How much did society pay for the care that newly covered people were getting before?
How much was lack of care affecting the economic productivity of the people who now have health coverage, and how much was those people’s reduced productivity costing society?
A careful analysis might (OK, probably will) show that ACA Medicaid expansion and the ACA public exchange program are inefficient ways to help poor, low-income people get and pay for care.
But an analysis could show that the Medicaid expansion and ACA public exchange plan programs are effective and efficient. If that’s the case, reimbursing insurers’ losses, as the ACA risk corridors was supposed to do for at least three years, might be a cost-effective strategy.
Even if a careful analysis shows that ACA, generally, is awful, understanding how the law affects covered people’s health and productivity might be useful in designing whatever new health system world that will come along after ACA.
If, for example, ACA Medicaid coverage expansion does improve some people’s ability to work, but at a very high cost, one way to proceed might be to look carefully to see what kind of newly covered services get the most bang for the buck.
Maybe there would be ways to get some of those productivity gains for a lower price in a new system.
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