The legal challenge to the Affordable Care Act (ACA), commonly known as Obamacare, and what the repercussions on healthcare access and affordability have been in sharp focus during this week’s Senate confirmation hearings for Judge Amy Coney Barrett. But something’s been missing from the media attention and opinions surrounding these discussions: How well is the program is meeting its intended goals?
After all, a program should not be measured by its intentions—it should be measured by its real-world results. Unfortunately, the ACA has fallen woefully short in both Arizona and across the country.
The law was passed, in part, with then-President Obama’s promise that “I have made a solemn pledge that I will sign a universal healthcare bill into law by the end of my first term as president that will cover every American and cut the cost of a typical family’s premiums by up to $2,500 a year.”
Unfortunately, average monthly insurance premiums have more than doubled, while the number of available insurers have dwindled. What is not well-known is that the ACA’s coverage gains have come mostly from the expansion of Medicaid—a program that was already facing long waits and obstacles to accessing care.
There are about 138,000 Arizonans currently enrolled in ACA coverage through the exchange. Of those, about 112,000 receive a federal subsidy for coverage. Compare that to the coverage gains from Arizona’s Health Care Cost Containment System (AHCCCS) program, which is Arizona’s Medicaid program: There are currently 2 million Arizonans who are participating in the ACCCS program. In October 2010, there were 1.3 million. While it is difficult to obtain an exact measure of how many people dropped their private coverage in favor of ACA coverage, it is estimated that about one-third of those covered by the ACA were previously insured.
Today, the patients most in need of help are now in the back of the line behind able-bodied adults as a result of handing out Medicaid cards to hundreds of thousands of Arizonans without any plan or viable strategy for caring for the most vulnerable. That is because the Medicaid expansion’s funding formula prioritizes healthy adults above the neediest patients. This is especially true in times of budget shortfalls, as most every state is now facing including Arizona.
A state seeking to rein in Medicaid spending would need to cut, on average, roughly more than $2 in Medicaid spending on the traditional Medicaid population to save $1 of state spending. Because the federal government is picking up most of the Medicaid spending for the expansion population, a state would need to cut up to $10 in Medicaid spending to save $1 in state spending—almost assuring services for the most vulnerable Medicaid populations will be first in line for budget cuts.
Most of us support a robust safety net for the most vulnerable among us. Unfortunately, the ACA has failed to deliver on the promises of healthcare access and affordability. Regardless of the outcome of the current ACA legal fight, there is much work to do to deliver on these unmet goals.
Arizona has already made important steps in making state-level reforms to address its healthcare challenges, including allowing for mid-level dental providers, corralling off Direct Primary Care from insurance regulators, expanding the scope of practice for nurse practitioners and certified registered nurse practitioners, and universal recognition which includes licensed healthcare professions.
While there is no silver bullet for the challenges facing the American healthcare system, we do know that the answer to our healthcare woes is not bigger bureaucracies and less accountability to the American people. The day of reckoning over if and how the state’s most vulnerable is going to be affected by the consequences of the “free” federal Medicaid that Arizona all too-willingly accepted is going to play out.
In the meantime, Arizona should continue to pursue market-based reforms that encourage competition and expand the access to and affordability of care for all consumers in a way that allows families to best meet their own healthcare needs and preferences.
Naomi Lopez is the Director of Healthcare Policy at the Goldwater Institute.