This editorial from The Lancet has a nice overview of the issues that continue to be associated with implementing The Patient Protection and Affordable Care Act. In particular, the piece focuses on how well the goals of the Affordable Care Act have been met. The main goal is to increase the number of Americans with health insurance. In that regard, the editorial argues, the Act has had some success, although it is still falling short of the projected goal. In the last month-and-a-half of 2014, 6.4 million Americans purchased a plan or re-enrolled in one. (Out of this group, almost 2 million were new enrollees.) At the current rate, almost 10 million Americans will have enrolled by the end of the current enrollment period on February 15. That is still significantly short of the original goal of 13 million, however. Nonetheless, the rate of uninsured Americans is the lowest it has been in nearly two decades, since 1997.
Another goal of the Affordable Care Act that the editorial identifies is improving the affordability and quality of health insurance. The legislative initiative in 2015 that will have probably the biggest impact in this area is the mandate that employers with over a hundred full-time employees must provide health coverage. (This is finally going into effect, after several delays.) In addition, there will be more options for individuals who want to switch plans, as 25-percent more insurers are offering them. On top of this, the greater number of choices will affect the cost of premiums. The assumption is that increased competition among insurers will lower costs, but this is hard to predict, as other factors can come into play.
A third goal, related to the second one, is to decrease the costs of health care borne by the government and individuals. One of the ways in which this has been accomplished is through a decrease in Medicaid reimbursements. Although reimbursements were raised temporarily for two years, the increase was discontinued at the close of 2014. With higher rates no longer in effect, physician fees have been reduced by 43 percent. While costs are now lower, the quality of care could be negatively affected, as these lower costs must cover the greater number of Americans who now have Medicaid. (The number of Americans covered has increased in recent years by about nine million, bringing the total to more than 60 million.) It is not clear, at this point, how future legislation can help achieve the goal of decreasing costs while still improving the quality of, and access to, care.
For more information on the current enrollment figures throughout the United States, go to this website. (The site distinguishes between confirmed and estimated figures.) The numbers on the site are updated regularly. For the enrollment figures on the site that are specific to Illinois, go here.
Another useful site, especially for policy analysis related to the Affordable Care Act, is the Urban Policy Institute. The site has a section that is specific to health policy. The analysis provided is especially helpful for tracking the relationship between costs and the number of insured and uninsured individuals.