THE BLOG
01/26/2015 11:20 am ET Updated Mar 28, 2015

The Verdict Is In: Obamacare Is Working Exactly As The Law Intended

Stop the fearmongering and lies: Obamacare is working -- and how.

We've heard all the dire warnings when Obamacare was passed in 2010: Health insurance premiums would skyrocket. The economy and job market would take a hit. Amwericans would lose healthcare choices and face so-called "death panels."

None of those dire warnings occurred, of course. Not a one. And based on a new health insurance survey by The Commonwealth Fund, a private foundation that promotes improvements to the nation's healthcare system, the law is working precisely as intended.

The foundation reported the number of uninsured Americans has dropped significantly since the last survey in 2012. In addition, the number of people saying they had trouble paying their medical bills fell from 75 million in 2012 to 64 million in 2013. That's the first time since the question was asked in 2005.

In addition, the number of American who say they didn't receive healthcare because of what it costs, fell for the first time since 2003 by going from 80 million in 2012 to 66 million in 2014.

The survey of more than 6,000 adults completed at the end of 2014 shows that only 23 percent of people didn't visit the doctor when they had a medical problem, down from 29 percent in 2012. Only 19 percent didn't fill a prescription in 2014, down from 27 percent in 2012.

"All of these declines are remarkable and unprecedented in the survey's history," says Sara Collins, The Commonwealth Fund's vice president for healthcare coverage and access and the study's lead author. "They indicate that the Affordable Care Act (or Obamacare) is beginning to help people afford the healthcare they need. We also found sharp declines in the uninsured rate nationwide. None of the fears cited by opponents have come through. It's been exactly the opposite. We're seeing millions of people getting health insurance coverage that wouldn't have been able to get it if not for the Affordable Care Act. We're also seeing millions of people getting access to healthcare that they wouldn't have been able to get before."

The number of uninsured working-age Americans fell from 37 million, or 20 percent, in 2010 to 29 million, or 16 percent, in 2014. Collins says. The largest declines were among people who were the most likely to have been uninsured in the past -- young adults and individuals with low incomes, she says.

The uninsured rate for those 50 and older uninsured rate is 11 percent, which is only a slight decline because that group is more likely to have health insurance than younger adults, Collins says. They're the lowest uninsured rate of any group with the exception 65 and older who are covered under Medicare.

"We're seeing increased access to healthcare because of the reforms of the Affordable Care Act both from the subsidies that have allowed people to buy health care and also the protection in individual markets that allowed people to get health plan where they wouldn't have gotten them before," Collins says. "These findings indicate that the insurance protections and new options for health insurance in the law are allowing people to get healthcare that they wouldn't have been able to afford to get in the past. The law's goals are working."

The survey shows the share of adults who said they had trouble paying their medical bills or could not pay them at all, fell from 30 percent in 2012 to 23 percent in 2014, Collins says. The percentage who had been contacted by a collections agency about unpaid medical bills fell from 18 percent to 15 percent; and the rate of adults paying off medical debt over time fell from 26 percent to 22 percent, she says.

Collins says those 50 and older have benefited tremendously from the Affordable Care Act if they're buying coverage on the individual marketplace if they don't have an employer to get it through. That group on the private market has always been at risk of having a medical conditions exclude them from coverage during an age they're more likely to have health problems, Collins says.

"Those protections really do benefit that age group if they're buying them on their own," Collins says. "We also see a lowering of financial barriers for people buying it on their own, many of which were in that age group over 50."

Prior to the enactment of the Affordable Care Act, those 50 and older, if they could get coverage, faced premiums several times higher than those who are younger and in better health. That same group is also now eligible for subsides that help lower the cost to make it even more affordable.

"The rating reforms were very important for this age group," Collins says. "Insurance carriers can't charge any more than three to one and that was not the case before in many states and older adults were charged much more than that relatively to younger adults. Those protections have really been important for older adults."

Any predictions of death panels or that somehow the Affordable Care Act is hurting people from getting medical care is patently false, Collins says.

"We're seeing the opposite," Collins says. "In the past, people have been shut out of healthcare because they didn't have health insurance. They couldn't afford it or get a plan if they were over 50 and had chronic health problems and were unable to get it through an employer. If they had a healthcare need, they faced exorbitant prices in paying for it. That's why we saw many times in reports of medical bill problems until this most recent period."

Collins says the survey doesn't look at improvements in people's health, but it's safe to assume they are getting healthier because of access to care and reduced financial barriers. Consumer protections in the law -- including a ban on lifetime and annual spending limit s-- is likely benefiting people, Collins says. That applies to both those who have insurance on their own or through and employer, she says.

What's still a concern, however, is that even with people with health insurance, there are people, especially, the lower income, who aren't getting access to the care they need, Collins says. The problem is the trend towards higher deductible plans that has people pick up a greater share of the cost, she says.

People without health insurance, including those with low incomes in states not expanding Medicaid, are still often finding healthcare costs beyond their reach, Collins says. Some 57 percent of adults who were uninsured during the year went without care because of the cost in the past year-and-a-half and 51 percent reported medical bill problems, she says.

Among those who were insured all year, people with lower incomes were the most likely to report affordability problems. According to the survey, 34 percent of insured adults making less than about $23,000 a year had trouble paying their medical bills or were paying off medical debt over time, and 33 percent reported they had not gotten needed health care because of the cost, Collins says.

"We do see in states that didn't extend their Medicaid programs higher rates of people reporting medical bill problems and people not getting health care that they need because of cost," Collins says. It's a significantly statistical difference in those states and we do know a number of people who are insured is much higher in states that didn't expand their Medicaid programs than those who did."

In states that have not expanded eligibility for Medicaid, uninsured rates among people with low incomes are still high: more than one-third (35 percent) of adults with incomes below the poverty level ($11,490 for an individual and $23,550 for a family of four) remained uninsured in 2014 in the 24 states that had not expanded Medicaid and started enrolling people by July 2014, when the survey was fielded, Collins says.

In contrast, only about one-fifth (19 percent) of low-income adults were uninsured in states that did expand Medicaid. Sixty-one percent of the remaining 29 million people without health insurance live in states that have not expanded Medicaid, Collins says.

Collins says the survey didn't address those who bought policies in the private marketplace and lost them because their insurance didn't comply with the Affordable Care Act. Those people were able to get policies that better protected them. Some had to pay more or had higher deductibles because of the improved coverage and many received subsidies, Collins says.

"We are seeing they had better health coverage as a group than they did in 2012," Collins says.

Although it wasn't part of the survey, Collins says the evidence shows that healthcare costs have moderated since the Affordable Care Act was passed in 2010. The concerns of "upward pressure on premiums hasn't panned out," she says. In looking at premiums in the state marketplaces in the first two years the exchanges have been in place, the average premium increase is zero, Collins says.

"There was a lot of variability across states," Collins says. "Some states saw declines in marketplace plans from 2014 to 2015 and some states saw increases. We're not seeing big increases as a result of the law in marketplaces. We are seeing very stable premiums and a competitive market with more insurance carriers that came in the marketplace this year. It's very robust competition in the reformed health insurance market."

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