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OBAMACARE: President Barack Obama and others report on health reform progress and future

If you are working up a presentation on the current and near term future of the health care system in the United States, take a look at this great source material.

President Barack Obama, writing a special communication in the first person, summarizes the effect of the first years of his landmark health reform legislation, the Affordable Care Act, popularly known as Obamacare.  Issued online July 11, the communication will also be published more formally in JAMA, the Journal of the American Medical Association, an influential journal intended for medical professionals but widely read in policy and academic circles as well.

The president opens by describing what it was like when he took office – the challenges of working through the Great Recession.  He discusses progress, noting that there has been a decline in the rate of insured Americans – from 16 percent in 2010 to 9.1 percent in 2015 – a 43 percent decrease.  He reviews how the health care delivery system has been changed, with movement toward alternative payment models.  Mr. Obama closes not only by expressing his sense of pride in the accomplishments to date but also by indicating how to build on progress and take the next steps.

WAIT, WAIT, there’s more!  This July 11 “online first” communication also includes related editorials by other eminent individuals.  Look below for more specifics on these sources.


Obama, B. (2016, July 11). United States health care reform: Progress to date and next steps. JAMA. Click here: http://jama.jamanetwork.com/article.aspx?articleid=2533698

Bauchner, H. [editor in chief, JAMA] (2016, July 11). The Affordable Care Act and the future of US health care. JAMA. Click here: http://jama.jamanetwork.com/article.aspx?articleid=2533694

Orszag, P.R. [Lazard] (2016, July 11). US health care reform: Cost containment and improvement in quality. JAMA.  Click here: http://jama.jamanetwork.com/article.aspx?articleid=2533695

Butler, S.M. [Brookings] (2016, July 11). The future of the Affordable Care Act: Reassessment and revision. JAMA.  Click here: http://jama.jamanetwork.com/article.aspx?articleid=2533696

Skinner, J. [Dartmouth], and Chandra, A. [Harvard] (2016, July 11). The past and future of the Affordable Care Act. JAMA.  Click here: http://jama.jamanetwork.com/article.aspx?articleid=2533697

Posted by AHA Resource Center (312) 422-2050, rc@aha.org



ACA: Surgeons assess the impact of the Affordable Care Act

The American College of Surgeons asked members of its Board of Governors to report on the effect of the Affordable Care Act on their surgical practice.  The following findings are based on responses from 208 U.S. surgeons.

  • There are more people who have health insurance
  • There are more people who have Medicaid coverage
  • There is a slight increase in surgical caseload
  • However, more patients are delaying elective surgery
  • And the surgeons report that patients are first coming for care at a later stage of disease

Source: Puls, M.W. (2016, May). 2015 ACS Governors Survey: Surgeons describe the ACA’s effects on access to care. Bulletin of the American College of Surgeons, 101(5), 19-24.  Click here: http://bulletin.facs.org/2016/05/2015-acs-governors-survey-surgeons-describe-the-acas-effects-on-access-to-care/  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

UNINSURED: Number of Americans lacking health insurance has decreased to 28.5 million in 2015

The number of Americans without health insurance has been decreasing, according to a survey conducted each year by the National Center for Health Statistics.  In 2010, there were an estimated 48.6 million Americans without health insurance.  As of the first half of 2015, that number had dropped to 28.5 million.  Let’s do the math.  That’s an improvement of 20 million people.

And for children, the results are also heartening.  In 2010, an estimated 5.8 million children were uninsured.  By the first half of 2015, that number had decreased to 3.3 million.  An improvement of 2.5 million.

Uninsured at the Time They Were Surveyed (all ages)

  • 48.6 million, or 16 percent (2010)
  • 46.3 million, or 15.1 percent (2011)
  • 45.5 million, or 14.7 percent (2012)
  • 44.8 million, or 14.4 percent (2013)
  • 36 million, or 11.5 percent (2014)
  • 28.5 million, or 9 percent (first half 2015)

These are federal government estimates based on the results of a sample survey of the civilian noninstitutionalized population of the United States.

Source:  Martinez, M.E., and Cohen, R.A. (2015, Nov.). Health insurance coverage: Early release of estimates from the National Health Interview Survey, January-June 2015. National Health Interview Survey early release program. Retrieved from http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201511.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org


FORECAST: Slowdown in hospital spending growth expected

Implementation of the Affordable Care Act (ACA) is intended to reduce the growth in hospital costs for Medicare patients directly, but this study analyzed the potential for associated decreases in costs due to the “spillover” effects related to lower utilization by non-elderly patients.  The analysis was based on data from 1995 to 2009.  Here is a nice brief summary of how Medicare reimbursement policy has affected costs over time.  This is a direct quote:

…Medicare, when first implemented, spurred broad increases in hospital capacity, with large spending spillovers among the nonelderly.  Our results describe a similar spillover but in reverse.  Medicare’s impact on the broader health system seems to depend on how Medicare pays providers.  In the 1960s and 1970s, Medicare paid hospitals very generously, and so the implementation of Medicare spurred spillover increases in spending and utilization among the nonelderly.  Over the period of our study, Medicare kept tight constraints on hospital payments, and those Medicare constraints appear to have contributed to falling inpatient hospital utilization rates among the nonelderly.  (pages 1592-1593)

The author, who is with RAND, concludes that the changes in Medicare due to the ACA will “slow the growth in hospital spending to a larger degree than has been projected.”

Source: White, C. (2014, October). Cutting Medicare hospital prices leads to a spillover reduction in hospital discharges for the nonelderly. HSR. Health Services Research. 49(5), 1578-1595.  Click here for access to article: http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12183/pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

HEALTH REFORM: Reduced mortality in Massachusetts after 2006 reform–good news for the nation?

Massachusetts provides an interesting test case for the nation because of the comprehensive health reform passed in the state in 2006 — reform which served as a model for the Affordable Care Act passed by Congress a few years later.  In this study, the authors (affiliated with the Harvard School of Public Health and the Urban Institute) compared all-cause mortality rates for adults aged 20 to 64 years between Massachusetts and other New England states before and after the reforms were initiated.

The principal finding was “a significant reduction in mortality among nonelderly adults in Massachusetts since its 2006 reform relative to a control group of similar counties in states without such reforms.”  Also of interest is the finding that the decrease in mortality tended to be concentrated in diseases that are treatable, at least in the short-term — cancer, infections, cardiovascular conditions.

The authors calculated a “coverage-to-mortality” ratio for a population that is gaining health insurance:  830 adults gaining insurance would tend to result in one death prevented per year.

Source: Sommers, B.D., Long, S.K., and Baicker, K.  Changes in mortality after Massachusetts health care reform: a quasi-experimental study.  Annals of Internal Medicine;160:585-593, May 6, 2014.  Click here for access to publisher’s website:  http://annals.org/article.aspx?articleid=1867050   Posted by AHA Resource Center (312) 422-2050, rc@aha.org



Community benefit programs: how to begin planning process

The Accountable Care Act mandates that tax-exempt hospitals show that they are looking at, and doing something about, community health needs.  In order to help hospitals accomplish this, the Catholic Health Association is going to publish a new 2012 edition of: A Guide for Planning and Reporting Community Benefit.  A little preview of the forthcoming publication is given in this article, which itemizes 7 general characteristics of a robust community benefit program.  These points include:

  • Mission-driven
  • Community health oriented (rather than charity-care oriented)
  • Actively engaging community members in planning
  • Transparent
  • Board and senior executive commitment
  • Strategically planned
  • Continuous quality improvement

Source: Trocchio, J., and Curtis, J.L.  Hallmarks for assessing a solid program.  Health Progress;93(3):64-65, May-June 2012.  Click here for full text on publisher’s website: http://www.chausa.org/HP/  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org