Column: 6 years later, more progress made possible by Affordable Care Act

In this Oct. 6, 2015, file photo, the HealthCare.gov website, where people can buy health insurance, is displayed on a laptop screen in Washington. (AP Photo/Andrew Harnik, File)

The United States spends more on healthcare than any other country in the world. In 2012, health spending accounted for approximately 16.9 percent of the United States’ GDP, compared to an average of 9.3 percent among other developed countries, according to the Office of Economic Co-Operation and Development.

The stark disparity has caused economists to offer a variety of explanations. Some economists rationalize that perhaps part of the reason we spend more on healthcare is because we “value” health more than other countries. We are personally willing to pay more for it even if increased individual spending only brings an increasingly small payoff, or increase in health.

However, the far more compelling, fundamental story is that too much healthcare in the United States is simply inefficient. It is centered more on treatment rather than prevention, the latter for which we can get greater, long-term increases in health for a much relatively lower price in the present, saving us both our money and, well, our lives.

This phenomenon inspired the emergence of the Affordable Care Act back in 2009. It also inspired Ronald Ackermann and David Marrero at the Indiana University of Medicine to research the impact of intervention-oriented prevention programs for pre-diabetes patients, both in terms of health and financial payoffs. 

One of their first experiments, conducted back in 2008, split more than 3,200 pre-diabetes patients into three groups: one subjected to an intensive “lifestyle” intervention including healthful eating and exercise, one given medicine that lowers blood glucose and the third a placebo. The study found that the intervention group had a 58 percent decrease in their risk of developing diabetes, compared to 31 percent for those simply taking medicine. 

Ackermann and Marrero quickly faced the challenge of real-life, wide scale implementation, with the cost of the program exceeding $1,400 per patient and doctors with little to no incentive to partake; however, in forming a partnership with YMCAs nationwide, they were able to create a community model of the intervention program, bringing the cost down to $205 per person.

The Affordable Care Act, which celebrated its sixth anniversary two weeks ago, has been able to give life to programs like Ackermann and Marrero’s brainchild, drawing back to their research conducted around the time when the ACA was first being debated.

After receiving a $12 million grant from the Center for Medicare and Medicaid Innovation, government actuaries found that if the intervention program was expanded to all Medicare recipients, the government would save over $2,500 per patient over the course of 15 months – far exceeding the cost.  

On March 23, Health and Human Services Secretary Sylvia Burwell announced that the department would expand such coverage to all Medicare beneficiaries. While this move may not be widely known, it will have a positive impact on patients, their families, and our healthcare system as a whole that cannot be overlooked.

Nor should the fact that it was made possible by the ACA, under which the secretary has the discretion to expand projects/programs if she finds they “reduce Medicare spending without reducing the quality of care, and if the Medicare actuary agrees.” Before now, this new benefit required approval in Congress. (The problems with this are self-explanatory: lengthy and unlikely). 

Pre-diabetes increases one’s risk of having a stroke, developing diabetes and heart disease – which is the leading cause of death in the United States and also happens to be preventable. To give an idea of the scope of the new program, more than 86 million people in the United States have pre-diabetes. “Treating [diabetes] isn’t just a burden on families,” Burwell said in the announcement, “it costs our nation $176 billion in direct medical costs ever year.” 

“Articles appear every day on ‘major breakthroughs,’ [in health services research], which later never pan out, while this one, full of successes, rarely make the news,” Aaron E. Carroll writes for The Upshot. “Health services research is more about hitting singles, day after day. There’s no billion dollar pay off, no fame, no Nobel Prize. But it gets the job done, and it’s often more likely to change the health of most Americans.” 

Another issue with research for health economists is that it oftentimes takes years after the implementation of any reform for effects to actualize, and thus be measured. The Diabetes Prevention Program is one example of the tangible benefits of Medicare expansions made possible through the ACA.

As we continue to shift our understanding of “good health care” and what we demand from our health care system, similar intervention, prevention-oriented programs should be encouraged, as they are both cost-benefit efficient and responsible.


Marissa Piccolo is associate opinion editor for The Daily Campus. She can be reached via email at marissa.piccolo@uconn.edu. She tweets @marissapiccolo.