America Under the Affordable Care Act

A report funded by the Robert Wood Johnson Foundation estimates the effects the Affordable Care Act (ACA) will have on how people get their health insurance, the number of people who will still have no insurance and America’s overall spending on health care.

The report, written by Urban Institute researchers, uses the Institute’s Health Insurance Policy Simulation Model (HIPSM) to predict results as if ACA were fully implemented in 2010 and contrasts those outcomes with HIPSM’s estimates for how these factors would look in 2010 without reform.

The findings show that under ACA:

  • The share of adults under age 65 without health insurance would decline by 28 million, from 18.6 to 8.3 percent.
  • Costs of uncompensated care provided to the uninsured would drop by 61 percent, from $69.6 billion to $27.3 billion.
  • Nearly 30 percent of those who would have been uninsured without reform would be covered by Medicaid or the Children’s Health Insurance Program (CHIP). Another 20 percent would be covered through the new health insurance exchanges and an additional 10 percent would be covered by private insurance outside the exchanges. Of the remaining 40 percent—those who would still be uninsured—most would be eligible for Medicaid or CHIP but are expected to choose not to enroll.
  • The expansion of Medicaid would enroll 13 million adults and nearly 4 million children.
  • About 44 million people under age 65 would be covered through health insurance exchanges. About half, 23 million, would be covered by nongroup insurance, the rest by employer-sponsored exchange plans.
  • Total spending on acute health care for the non-elderly by the government, employers and individuals would increase by 4.5 percent, or $53.1 billion if ACA were fully implemented in 2010. This estimate does not, however, take into account the cost-savings that are likely to occur from multiyear provisions such as Medicare and Medicaid savings and cost-containment programs.

The report’s single-year estimates complement the 10-year cost estimates from the Congressional Budget Office (CBO) and the Centers for Medicare and Medicaid Services (CMS). It provides estimates—particularly for coverage and transitions in coverage—that are new or more detailed than the CBO or CMS estimates.