The central achievement of the Affordable Care Act is hard to debate: The uninsured rate has dropped substantially.
And yet, as many critics are quick to point out, health care has not necessarily become more affordable for many of the people the law was intended to help. Many supposed beneficiaries of the law are still strained financially by steadily growing medical costs, as well as the high price of insurance that many of them were required by law to purchase.
As Modern Healthcare reports, the U.S. Census indicated that 11.2 million Americans were forced into poverty because of out-of-pocket medical expenses in 2015.
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Those who truly experienced the closest thing to an ideal outcome from the ACA were the millions who gained free or near-free Medicaid coverage in states that opted to raise the program's eligibility limit to 133 percent of the federal poverty level.
But many of those with higher incomes who were required to buy insurance through healthcare.gov encountered plans they found unaffordable because of high monthly premiums and even higher deductibles.
The great majority of customers were eligible for tax credits to offset the cost of the premiums and a substantial minority were eligible for additional subsidies to offset out-of-pocket costs, but many still find the costs crippling in the event of a serious medical event.
Numerous studies have shown that many of those who have high-deductible health plans do not have the savings necessary to cover the entire deductible if necessary. One by the Kaiser Family Foundation last year found that only half of families over the poverty limit have the cash on hand to cover a $2,500 individual deductible or a $5,000 family deductible.
The problem is that policymakers find themselves confronting two competing goals: lowering health costs for individuals and slowing the growth of health care costs nationally. Many believe that the latter goal will be accomplished by encouraging high-deductible or consumer-driven health plans that force people to share a greater portion of health costs.
The ACA originally included a provision, dubbed the "Cadillac Tax," which would encourage employers to move away from extremely expensive health plans by subjecting plans over a certain cost to a steep tax. But its implementation suspended for two years as part of a bipartisan budget compromise late last year, and few leaders in either party have shown an appetite to revive it.
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