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One year into Obamacare: where is it now?

By Jeanne Lenzer
BMJ, Dec. 5, 2014

[Excerpts]

About one year since the launch of the Patient Protection and Affordable Care Act’s insurance exchange program, the overwhelming majority of the 48 million people who were uninsured in 2012, remain uninsured — a problem that will persist for the next 10 years, according to government projections. The Congressional Budget Office estimates that 37 million people will not have health insurance in 2015 and 31 million will be uninsured in 2024.

About 6.7 million (corrected from an earlier estimate of 7.3 million) were newly insured under the act known as Obamacare during 2014.

Access to insurance has been liberalized in several ways: insurers may no longer deny coverage to individuals with pre-existing illnesses; young adults under age 26 may remain on their parents’ policy; and Medicaid has been extended to include some poor single adults and adults without children. …

According to a study by the Kaiser Family Foundation, “The ACA [Affordable Care Act] establishes an affordability standard for health insurance premiums, but not for out-of-pocket medical expenses. Even with limits on cost-sharing established under the ACA, deductibles and other cost-sharing will continue at a level above what many people could afford if a significant illness or injury strikes.”

It was hoped that reducing the number of uninsured people would also reduce the number of people putting off medical care because of costs. However, according to a Gallup poll conducted in early November 2014, the proportion of families who put off medical treatment rose from 30 percent in 2013 to 33 percent in 2014. The proportion of people with serious medical problems who put off treatment increased from 19 percent to 22 percent. ...

Progressive challenges to Obamacare include a bill introduced in Congress (HR 676) to establish a universal single payer healthcare system. Physicians for a National Health Program supports the bill, which it says could slash administrative costs by more than $400bn annually and solve many of the problems of the act — including providing care for the estimated 31 million people who will still be uninsured in 2024 under Obamacare.

Full text of article, including citations: http://www.bmj.com/content/349/bmj.g7405