Affordable Care Act

One interesting thang about the ACA is that health care inflation slowed significantly in the decade after its implementation compared to the prior decade, both in absolute terms and relative to overall inflation.

Moreover, the rate at which healthcare spending as a percentage of GDP was growing also slowed significantly. In spite of demographics (an aging population) and increasing rates of obesity.
For a program that is an unquestioned failure those are impressive results.

And incidentally, the number of uninsured Americans dropped sharply.
 
There are lots of public goods that require unfathomable subsidies. Such as national defense. Education. Highways. The alleviation of poverty. It is up to us as a society to decide these thangs. Obamacare curbed healthcare inflation. It curbed the rate at which healthcare spending was increasing as a percentage of GDP. In spite of things like an aging population, the obesity epidemic and the opioid epidemic. And it greatly reduced the number of people without health insurance. There is an impressive body of research showing how states who have declined to participate have suffered very poor outcomes relative to those who have.
 
what is the evidence on outcomes in states that accepted obamacare subsidies versus those that didn't

ChatGPT said:​


Thought for 13s

Short answer: states that adopted the ACA’s Medicaid expansion (and other key ACA features) show consistently better population-level outcomes than states that did not — notably much larger drops in uninsured rates, better access and use of care, improved financial protection (less medical debt and uncompensated care), stronger hospital finances (especially for safety-net and rural hospitals), and accumulating evidence of reduced mortality — although effect sizes vary by study, population, and time period. Below is a concise, evidence-backed summary with the most important citations.

Quick evidence summary​

  • Big increases in coverage / big drops in uninsured rates. Expansion states saw large reductions in uninsured rates for low-income adults (often 10–20 percentage points for the target populations) versus much smaller changes in non-expansion states. KFF+1
  • Improved access and utilization. Expansion is tied to increased primary care visits, prescription fills, preventive services, and fewer unmet care needs due to cost. The literature finds consistent coverage → access effects in expansion states. KFF+1
  • Financial protection for households. Studies show expansion reduced unpaid medical bills, collections, and medical-debt filings among affected low-income adults. PMC
  • Lower uncompensated care / better hospital finances (especially safety-net & rural hospitals). Hospitals in expansion states saw sharp drops in uncompensated care and improved margins; non-expansion states experienced higher uncompensated care burdens and many rural hospital closures disproportionately occurred in non-expansion states. Commonwealth Fund+2GQ+2
  • Emerging and growing evidence of mortality reductions. Multiple quasi-experimental studies and recent working papers find that Medicaid expansion is associated with reduced all-cause mortality among low-income adults (estimates vary: a few percent reduction in mortality for the low-income adult population in some papers; other broader estimates translate to relative reductions on the order of ~2–6% depending on study and population). These results are stronger when studies have broad geographic scope and longer follow-up, but effects vary by state and subgroup.
 
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