With the 2020s well underway, now is a great time to examine the changes that marked the evolution of healthcare over the past 25 years.
Just months into 2010, President Obama signed the Patient Protection and Affordable Care Act (PPACA) into law. The Affordable Care Act, used interchangeably with the ACA marketplace, the real name for Obamacare, changed the nation’s health insurance landscape by bringing about numerous provisions to help make health insurance more affordable and accessible to as many Americans as possible.
Some key provisions include:
Ten years later, uninsured rates have declined. In 2010, nearly 16% of Americans were uninsured. But in 2016, the uninsured rate hovered just above 8% - its lowest point in the decade. Although, it started to increase again slightly in 2017.
Short-term health insurance is temporary insurance that provides coverage in certain medical situations like an unexpected accident or illness. However, it doesn't include the same essential health benefits that ACA plans do, making it a more affordable insurance option for many.
Short-term health plans remained a relevant health insurance option throughout the decade with sales increasing sharply after the ACA took full effect in 2014. These plans became an attractive option for people who were exempt from the individual mandate or opted to pay a penalty for not having an ACA-compliant health plan.
Obama limits short-term policies
Concerned that short term health insurance was impacting ACA enrollment, the Obama administration created regulations that limited their availability. In 2016, short term health insurance policy durations were capped at three months.
Trump expands short-term policies
In 2018, the Trump administration lifted Obama-era limits. Policies can now last up to 12 months and can be renewed for up to 36 months, depending on state laws. Arizona, for example, has adopted the Trump administration’s regulation. Some states, such as Oregon, still limit short-term plans to less than 90 days.
High-deductible health plans, called HDHPs, were introduced in the early 2000s and were considered "mainstream plans" by 2012. People obtained these plans usually through their employer group-based coverage (if offered), the healthcare exchange, or from private insurers.
Here are some interesting facts:
But while consumers can appreciate the lower monthly premium of a high-deductible insurance plan, they also tend to delay or skip medical care because of the high out-of-pocket costs associated with HDHPs.
The popularity of HDHP may be slowing - at least in the group market. The percentage of employers offering a high-deductible health plan as the only option is projected to decrease in 2020, with more employers beginning to offer additional coverage options.
If it seems like your healthcare costs increased throughout the past decade, it probably did. In 2018, the average American household spent $5,000 on healthcare, with nearly 70% of the $5,000 going towards health insurance.
The more staggering fact: medical bills are reported to be the number one cause of bankruptcies nationwide. And today, medical costs are considered America’s "real healthcare crisis". And while politicians continue to debate issues including health insurance reform and prescription drug pricing, they have not agreed upon a clear solution.
Until things change, consumers must continue to find ways to save on their own, from finding flexible and affordable health insurance options and taking advantage of preventive care, to comparing provider rates before seeking services and getting alternative healthcare through options like telemedicine.
Another wave of opioid-related deaths hit around 2013 and this time, synthetic opioids like fentanyl were behind the surge. The crisis continued to escalate from there, with prescription drugs playing a significant role.
Here are some of the most shocking reports:
So what’s being done about it? In early 2019, the Trump administration launched a $353 million initiative to cut opioid overdoses by 40% over the next three years.
The federal government is also working to hold drug companies accountable. For example, top executives at Insys Therapeutics were found guilty of racketeering conspiracy—a charge typically assigned to drug dealers and mob bosses.
In 2018, the CDC reported that drug overdose deaths decreased for the first time since 1990.
The 2020 pandemic was not only the biggest health event in the U.S. in the past decade, but a major burden on an already fragile healthcare system. From shortages of hospital beds and staff to healthcare facilities having to ration medical supplies to keep up with COVID-19 cases, we’ve seen how our healthcare infrastructure is in need of improvements to better prepare for crises.
Not only that, researchers at the Massachusetts Institute of Technology assert that the pandemic revealed some deeper issues in our healthcare system, such as disproportionate access to care among marginalized groups and the country’s dependence on healthcare services from underpaid workers.
Weight loss treatment has changed and advanced significantly over the last 25 years, with breakthroughs in medical knowledge, technology, and a greater understanding of and insights into the complexities of obesity.
Medicare Advantage plans, which are an alternative to Original Medicare, have seen a steady increase in enrollment each year over the past decade. As of 2022, there are 28.4 million Medicare Advantage enrollees which account for 48% of the Medicare-eligible population. People enrolled in MA plans back in 2012 represented about a quarter of all beneficiaries, so enrollment rates have just about doubled.
Another interesting fact as reported by Kaiser Family Foundation is that “the average Medicare beneficiary in 2022 has access to 39 Medicare Advantage plans, the largest number of options available in more than a decade.”
Here’s a breakdown of MA plan enrollment:
Discussions about healthcare reform and our healthcare landscape did not stop when the ACA was passed. Conversations about legal challenges continue to this day. There has been proposed legislation to repeal and replace the ACA under the Trump administration.
New tax legislation passed in December 2017, which changed one key aspect of the ACA. Previously, you could be penalized for not having health insurance, but Congress and President Trump eliminated the mandate rule for all coverage beginning Jan. 1, 2019.
The 5th Circuit also ruled in Texas vs. United States that the individual mandate is unconstitutional, at which time, a A Texas Judge was deciding what, if any, of the ACA still stands. But in 2021, the Supreme Court ruled that states don’t have any grounds to challenge the constitutionality of the ACA mandate.
With the Presidential election in 2020, Democrats were focused on building upon the ACA with tactics like a “Medicare for all” national health insurance system. However, this agenda never took effect with the Democratic party winning the election.
Now twelve years after the passing of the ACA, the Biden-Harris administration has promised to continue upholding the ACA and making affordable health insurance accessible. With ongoing talks of a universal health insurance option for Americans and how to navigate health-related issues post pandemic, there’s no doubt that healthcare legislation will continue to make headlines over the next decade.
Over the last 25 years, health has continued to undergo significant changes and advancements. Here's a summary of some key developments in health during this period that will drive changes to healthcare in the future:
Advancements in Medical Technology: The rapid progress in medical technology has transformed healthcare. Diagnostic tools like MRI and CT scans have become more accessible, allowing for earlier and more accurate disease detection. Telemedicine and wearable health devices have also gained popularity, making healthcare more convenient and accessible.
Precision Medicine: The concept of precision medicine has gained prominence. This approach tailors medical treatment and prevention strategies to individual genetic, environmental, and lifestyle factors. It has the potential to enhance the effectiveness of treatments and reduce adverse effects.
Vaccines: Vaccines have continued to be a cornerstone of public health. The development of new vaccines, such as those for HPV and shingles, has expanded protection against various diseases. Additionally, the rapid development and distribution of COVID-19 vaccines in response to the pandemic showcased the agility of vaccine research and production.
Genomic Medicine: The Human Genome Project, completed in the early 2000s, laid the foundation for genomic medicine. Since then, there have been significant breakthroughs in understanding genetic factors in diseases, enabling personalized treatment and risk assessment.
Mental Health Awareness: There has been a growing recognition of the importance of mental health. Efforts to reduce stigma and increase access to mental healthcare have expanded, acknowledging that mental well-being is an integral part of overall health.
Chronic Disease Management: With an aging population, there has been a focus on managing chronic diseases more effectively. New medications and therapies have been developed to improve the quality of life for individuals with conditions like diabetes, heart disease, and cancer.
Global Health Challenges: The last 25 years have seen several global health challenges, including the HIV/AIDS epidemic and the COVID-19 pandemic. These crises have led to increased international cooperation and a greater emphasis on pandemic preparedness.
Health Information Technology: Electronic health records (EHRs) have become widespread, streamlining patient data management and improving communication among healthcare providers. This digital transformation has the potential to enhance patient care and research.
Lifestyle and Preventive Health: There's a growing emphasis on preventive health measures, including healthy diet and exercise. Public health campaigns and initiatives have aimed to reduce smoking rates and combat obesity.
Overall, health over the last 25 years has been marked by technological advancements, a shift toward personalized medicine, increased awareness of mental health, and responses to global health challenges. These changes have collectively contributed to improving healthcare outcomes and the overall well-being of individuals worldwide.
From Obamacare to the opioid epidemic to the Covid-19 pandemic, healthcare-related issues have made major headlines. And it’s inevitable that they’ll only continue to evolve and impact our lives for years to come.
We’ll continue to follow the trends and changes as well as their impacts on our nation.
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