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ACA may not be ‘terrific,’ but it’s making a difference

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Wanda Morrison, 61, with her physician, Dr. Kimberley Brumleve, at the Family Health Center in of Louisville.
Wanda Morrison, 61, with her physician, Dr. Kimberley Brumleve, at the Family Health Center in of Louisville.NYT

From the day the Affordable Care Act was signed into law more than six years ago, Republicans have vowed to repeal the sweeping legislation that so far has extended medical coverage to more than 20 million previously uninsured Americans. Following in that dubious tradition, Donald Trump has made overturning the law a marquee issue of his presidential campaign, vowing to replace it with “something terrific.” Their criticisms are many, but most revolve around the insurance program being too expensive and cumbersome for businesses and individuals. And, they dislike that it was built on what they consider an objectionable “individual mandate.” Yes, there have been many bumps along the way — and a few gaping holes that still need to be filled — but various studies and analyses indicate that the ACA is working to cut medical debt, and greatly reduce the number of people who are without insurance. It’s far from perfect, but even further from failure.

Now, a new study finds that the law may be helping to improve the lives of low-income people who previously received most of their health care in hospital emergency rooms. It looked at several states where some low-income residents did not qualify for Medicaid, the federal government insurance program for disabled people and the poor. Under a momentous 2012 US Supreme Court ruling, states are not obligated to expand Medicaid coverage to these residents under the ACA. In Arkansas and Kentucky, two states that opted to do so, the study found people were taking better care of themselves, compared with those in Texas, which chose against Medicaid expansion. The comparison is more nuanced than that, of course, but in general, low-income residents who had health insurance for the first time were more likely to turn to a primary care doctor instead of the ER, fill prescriptions for medications, and to seek routine preventive care, like glucose tests, cholesterol screenings, and blood-pressure monitoring

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The study was published last week in the journal JAMA Internal Medicine. Its author, Benjamin Sommers, is quick to point out that none of this is immediately saving money — people with insurance go to a doctor more often than those who have to foot the entire bill. But Sommers, an assistant professor of health policy and economics at Harvard's T. H. Chan School of Public Health, also notes that the federal dollars from expanded Medicaid coverage can help boost a state's health care industry, particularly in low-income areas. That raises a point that ACA critics often ignore: Ultimately, the goal of the legislation is to make Americans healthier. As that happens, over time there likely will be cost savings.

"There's a social contract part of this," says Sommers. "Is it fair for the richest country in the world to have people not to be able to afford their medical care?"

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It's something for Trump to think about before launching into his next rant against "Obamacare." He might even want to discuss it with his vice presidential running mate, Mike Pence. Last year, the Indiana governor decided to start accepting additional Medicaid funding for his state. He's investing it in an innovative program called Healthy Indiana Plan 2.0, which provides insurance to adults earning up to 138 percent of the federal poverty level, if they agree to put a modest amount of money in a health savings account. As of January, nearly 350,000 were participating. Not quite the Affordable Care Act "disaster" of Trump's rhetorical theatrics.