Some of the key findings:
- Surveys show that 7.8 million young adults, 19-25 years, were enrolled in a parent's plan and that most of them wouldn't have been able to do so before the law. The result, according to federal studies, is that the number of uninsured young people dropped by 1 million since the law took effect, with 3 million now uncovered. A fun tidbit—more of these young people covered by their parent's plans identified themselves as Republican than Democrat in a Commonwealth survey.
- The health insurance market off of the exchanges that was set up under the law had a robust year, with the CBO projecting 5 million people gaining coverage outside the exchanges. That's directly attributed to the law's passage, both the individual mandate that people must have coverage and the fact that insurance companies now can't charge huge premiums or shut people out of insurance entirely because of their health status.
- The enrollment numbers for 2014, and the risk-sharing provisions of the law that help equalize the coverage burden for insurers, should mean modest premium increases for 2015—Kaiser Family Foundation says they could be as low as 1 to 2 percent.
- One of the things keeping premiums low could be a problem going forward: many plans have very narrow networks of providers they'll cover services from. Some people will probably leave those plans if they find that they're not getting access to the doctors and hospitals they want or need and might not be able to afford a plan with a larger network. The administration and the several of the states are looking at how much of a problem these narrow networks are, and what can be done to address the problem.
- So far, 6 million people—adults and children—have gained Medicaid or CHIP coverage. That number will keep increasing because people can sign up for it at any time, and it includes people in the non-expansion states who discovered they were eligible for traditional Medicaid when they tried to enroll in an exchange. These authors are optimistic about the non-expansion states eventually coming around. They point out that it took about six years for most states to opt in to Medicaid after it passed in 1966, and Arizona waited until 1982.
The authors caution that this is just a status check, not a measure of success or failure of the law, because it's really too soon to say how it's going to play out in the coming months and years. Beyond that, the experience among the states already has and is going to continue to differ. Gallup has already shown that states that embraced the law, worked to make the exchange work and to get the word out, and expanded Medicaid have less of a problem with uninsured rates.
Ultimately, though, they say the success of the law is going to be determined by whether the government and the industry can reduce costs in the system, and that "developing and spreading innovative approaches to health care delivery that provide greater quality at lower cost is the next great challenge facing the nation." Healthcare reform is far from done now.