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The Affordable Care Act is working.  2.5 million more young adults ages 19 to 26 now have health insurance.  The shrinking of the Medicare "donut hole" allowed 3.6 million seniors to save $2.1 billion on their prescription drugs last year.  And the ban on insurers refusing to cover pre-existing conditions is saving lives (even among those who opposed so-called "Obamacare").  And even though most of its provisions don't into effect until 2014, the data from Oregon and Massachusetts strongly suggest the 30 million people who will gain coverage will be much healthier and more financially secure.

In Massachusetts, the 2006 health care reform Governor Mitt Romney signed into law lowered the uninsured rate from 10 percent to a national low of two percent.  Even with its individual mandate, "Romneycare" is extremely popular, enjoying a 3 to 1 margin of support from Bay State residents.  Now, a new study by Charles J. Courtemanche and Daniela Zapata published by the National Bureau of Economic Research (NBR) shows that universal coverage in Massachusetts is indeed making people there healthier.  As Ezra Klein of the Washington Post summed up their findings:
The answer, which relies on self-reported health data, suggests they did. The authors document improvements in "physical health, mental health, functional limitations, joint disorders, body mass index, and moderate physical activity." The gains were greatest for "women, minorities, near-elderly adults, and those with incomes low enough to qualify for the law's subsidies."
Importantly, the researchers concluded that "the general strategies for obtaining nearly universal coverage in both the Massachusetts and federal laws involved the same three-pronged approach of non-group insurance market reforms, subsidies, and mandates, suggesting that the health effects should be broadly similar."  (Or MIT professor and architect of both laws Jonathan Gruber put it bluntly last year, "they're the same f--king bill.")  It's no wonder Mitt Romney used to recommend his Massachusetts reform as a model for the nation.

If the individual mandate is one of the highest profile (if contentious) aspects of the 2010 Patient Protection and Affordable Care Act, the expansion of Medicaid is among the most important in enabling 30 million currently uninsured Americans to get coverage.  By extending Medicaid coverage to families earning up to 133% of the federal poverty level (FPL) and providing subsidies to those up to four times the FPL, starting in 2014 the Affordable Care Act passed by Democrats in Congress will bring insurance to millions more Americans. A March 2011 analysis by the Commonwealth Fund revealed that revealed that when fully implemented, the ACA will bring relief to "nearly all of the 52 million working-age adults who were without health insurance for a time in 2010."

As it turns out, America's future is Oregon's present.

That's the word from another study released last fall by the NBER.  The same nonpartisan group that determines the official beginning and end of recessions, NBER found, as Harvard researcher and former member of President George W. Bush's Council of Economic Advisers Katherine Baicker put it, "Medicaid matters."

The NBER study avoided the pitfalls of past studies by examining the case of Oregon. After Oregon in 2008 established a lottery to add 10,000 people to it limited Medicaid rolls, the NBER team interview 6,000 of the lucky ones and 6,000 of the 90,000 who lost out.  The results were striking:

We find that in this first year, the treatment group had substantively and statistically significantly higher health care utilization (including primary and preventive care as well as hospitalizations), lower out-of-pocket medical expenditures and medical debt (including fewer bills sent to collection), and better self-reported physical and mental health than the control group.
The New York Times provided some of the details of the Medicaid success story:
Those with Medicaid were 35 percent more likely to go to a clinic or see a doctor, 15 percent more likely to use prescription drugs and 30 percent more likely to be admitted to a hospital. Researchers were unable to detect a change in emergency room use.
Women with insurance were 60 percent more likely to have mammograms, and those with insurance were 20 percent more likely to have their cholesterol checked. They were 70 percent more likely to have a particular clinic or office for medical care and 55 percent more likely to have a doctor whom they usually saw.
The insured also felt better: the likelihood that they said their health was good or excellent increased by 25 percent, and they were 40 percent less likely to say that their health had worsened in the past year than those without insurance.
As Ezra Klein of the Washington Post summed up the findings, "knowing that Medicaid matters is good, but we already sort of knew that."

It is also worth noting, as Ezra Klein does, that the Massachusetts analysis may understate the health care gains to all Americans, and not just the uninsured:

The national reforms, unlike the Massachusetts reforms, included major investments in comparative-effectiveness research, electronic health records, accountable care organizations and pay-for-quality pilots. If any or all of those initiatives pay off, they could dramatically improve our understanding of which treatments work and force the health-care system to integrate that new knowledge into everyday treatment decisions very quickly.

If that happens, medical care could become substantially more effective than it is now, which should also improve health outcomes. Quality improvements like that could, for the already insured, be the largest payoff from the Affordable Care Act.

Alas, those improvements have already carried a steep price for the Democratic Party and the cause of truth.  As Jonathan Chait reported last week, a recent paper suggested (though not convincingly) that Democrats' support for the ACA cost them their House majority in November 2010.  Meanwhile Republicans whipped up opposition with a torrent of lies about "death panels", a "government take-over of health care", added debt and "Medicaid ghettoes" and other smokescreens that continue to obscure the truth about President Obama's health care reform.

The truth, for starters, that the Affordable Care Act is working.

* Crossposted at Perrspectives *

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Comment Preferences

  •  Way cool. (3+ / 0-)
    Recommended by:
    fcvaguy, Cedwyn, boredwitnuts

    Cats are better than therapy, and I'm a therapist.

    by Smoh on Wed Mar 14, 2012 at 12:09:19 PM PDT

  •  brother lippy is benefiting from "Romney care" (6+ / 0-)

    in MA.

    It really does make a huge difference to many people. Soon, Lippy the younger will benefit from my employer-provided health insurance beyond the age at which he would have cut off formerly.

    This will allow him to develop a lot more of his own skills and test out some career starts without his biggest worry being whether he'll had health insurance. Makes sense, and I've seen tangible benefits even in my own very small sample size.

    Thanks for this informative take. Tipped, rec'd.

    Fear is the mind-killer - Frank Herbert, Dune

    by p gorden lippy on Wed Mar 14, 2012 at 12:09:49 PM PDT

  •  Don't tell Arianna. (2+ / 0-)
    Recommended by:
    boredwitnuts, samddobermann

    The HuffPo needs more rage.

  •  This singular piece of legislation will go down (1+ / 0-)
    Recommended by:

    in this country's history as a turning point, IMHO.  Millions of Americans will have affordable healthcare and will not have to go bankrupt if they get sick as a result of this legislation.

    How sick, mentally and emotionally, are creepy Republicans who work day and night to deny this coverage to average and poor Americans?  How sick and creepy and EVIL is it to make a profit off peoples' health issues?  Super sick, IMHO.

    The only death panels that exist in this country are owned and operated by for-profit health insurers supported by paid operatives in the creepy GOP.


    Best. President. Ever.

    by Little Lulu on Wed Mar 14, 2012 at 12:43:58 PM PDT

  •  The expansion of Medicaid to child free adults (0+ / 0-)

    Which is supposed to happen by 2014, is a big deal in the states that cut them out completely now, no matter how poor they are. I can't tell you how many men I have seen with problems that couldn't get any help at all.

    Please sign the White House petition to Flush Rush from AFN (Armed Forces Network).

    by splashy on Thu Mar 15, 2012 at 01:53:16 AM PDT

  •  Gruber is an attention whore ass (0+ / 0-)

    He was not the Architect of both laws.

     (Or MIT professor and architect of both laws Jonathan Gruber put it bluntly last year, "they're the same f--king bill.")
    The refutation of that comes in your diary from Ezra Klein:
    The national reforms, unlike the Massachusetts reforms, included major investments in comparative-effectiveness research, electronic health records, accountable care organizations and pay-for-quality pilots.
    They aren't near the same. They are very similar on the coverage issue but there a hell of a lot different provisions binding insurers. And the coverage issue was only in Title I of the ACA. The rest of the bill, Titles II through X covered many different things.

    In Mass they went on the policy of getting coverage first then later working on cost. No effort was made on quality.

    Recall that Obama, from his campaign on said there were three aspects that had to be covered: coverage, quality and cost. The ACA covers most everything that he talked about in his campaign materials, although he didn't get everything he discussed.

    Ezra talks about some of the improvements in quality but he doesn't tie in, and likely hasn't know that improving quality reduces health care costs dramatically.

    People mocked the bill for its length but there is a lot more in it than coverage. Most of it hasn't been in the awareness of many people.

    I keep trying to write some diaries on it and the problems that the bill is trying to fix.

    Another facet no one is discussing is the the ACA is a jobs bill!

    I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

    by samddobermann on Thu Mar 15, 2012 at 04:11:55 AM PDT

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