“Just the Facts” About the Affordable Care Act

I grew up watching the TV classic Dragnet, which ran on NBC from 1951 to 1959 and then from 1967 to 1970. Each episode opened with a dramatic four-note brass-and-tympani musical theme and the warning, “The story you are about to see is true. Only the names have been changed to protect the innocent.” I still quote producer and actor Jack Webb’s Sergeant Joe Friday, whose interviews with witnesses were punctuated with “Just the facts, ma’am, just the facts!”

After listening to the news coverage and audiotapes of the unprecedented three days of U.S. Supreme Court hearings on the constitutionality of the Affordable Care Act—all related to speculations about what might happen in 2014 and beyond (when the government might even mandate broccoli consumption, according to one justice)—I began to hear Sergeant Friday’s gravelly voice: “Just the facts, ma’am!”

I thought you might be interested in what the Affordable Care Act (ACA) has actually already done in the two years since President Obama signed it into law on March 23, 2010 (with apologies to Harper’s Magazine’s “Index”):

• Individuals with preexisting conditions who now have secured health insurance: 48,879
• Children with preexisting conditions protected against health-insurance denials: 17,600,000
• Insured patients who received preventive services without co-payments or deductibles: 54,000,000
• Medicare patients who received such co-payment- and deductible-free preventive services: 32,500,000
• Seniors who used new Medicare pharmacy benefits: 3,600,000
• Average annual savings in prescription-drug costs for these seniors: $604
• Increase in senior participation in Medicare Advantage: 17%
• Reduction in premiums for Medicare Advantage: 16%
• Insured individuals who no longer have lifetime coverage limits: 105,000,000
• Individuals whose insurance companies must now devote 80% of their income to paying for healthcare: 76,000,000
• Small businesses receiving tax credits for providing health coverage for their employees: 360,000
• Small-business employees receiving health insurance supported by these tax credits: 2,000,000
• States already building health-insurance exchanges: 33 (plus the District of Columbia and, as of April 12, 2012, New York)
• Federally recognized Accountable Care Organizations: 32 Pioneers; 27 added on April 10, 2012; and 150 in the application pipeline (Montefiore is the only Pioneer in New York)
• Medicare and Medicaid fraud prosecutions in FY2011: 1,430
• Increase in such prosecutions compared to FY2008 with tools provided by the ACA: 74%
• Correction in the 10-year projection for deficit reduction by the Congressional Budget Office for the impact of the ACA: $50,000,000,000 more than the original projection of $143,000,000,000
Source: U.S. Department of Health and Human Services

Whenever I lecture on what the ACA does now and plans for the future, I always first ask my audience members, primarily health and social-service professionals, to raise their hands if they understand the law. Never are more than one or two hands raised. According to tracking polls by the Kaiser Family Foundation, opinions are strongly and equally divided for and against the law and largely unchanged since its passage.  From the poll:

• Americans  who believe the U.S. Supreme Court has already overturned the ACA and believe it is no longer law: 14%; those polled who don’t know: 28%
• Americans who say they have not been personally affected by the ACA: 67%

As the facts above show, the ACA has already had a huge impact. To adapt a familiar phrase, never have so many felt so strongly based on so little information.  And never have the benefits of legislation been so invisible to the public.