From Obamacare to the opioid epidemic, healthcare-related issues have made headlines over the past decade. And it’s inevitable that they’ll only continue to evolve and impact the decade ahead.
With the 2020s underway, let’s take a look back at five key milestones and issues that marked the evolution of healthcare over the past decade.
1. The Affordable Care Act became the law.
Just months into 2010, President Obama signed the Patient Protection and Affordable Care Act (PPACA) into law. The Affordable Care Act, often referred to the ACA or Obamacare, changed the nation’s health insurance landscape as we knew it.
The healthcare reform law brought about numerous changes to help make health insurance more affordable and accessible to as many Americans as possible. Some key provisions include:
The creation of a health insurance marketplace in every state to provide consumers with a place to purchase health insurance.
Income-based subsidies, including premium tax credits and cost-sharing reductions, for those who purchase individual coverage through the health insurance marketplace (i.e., the state-based and federal exchanges).
A requirement that insurance plans cover young adults on their parents’ policies to age 26.
Guaranteed issue and renewal of policies.
Premium rating rules that limited pricing to five things: location, age, tobacco use, individual or family enrollment, and plan category (i.e., bronze, silver, gold, platinum, catastrophic).
An individual mandate requiring most Americans to have health insurance that qualified as minimum essential coverage or pay a tax penalty, unless they qualified for an exemption. (As of Jan. 1, 2019, the tax penalty has been rescinded).
Medicaid expansion to those with incomes below 138% of the federal poverty level, in participating states.
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. It started to increase again slightly in 2017.
But premiums increased 105% from 2013 to 2017 while the market adjusted to enrollment numbers and the resulting risk pool. Premiums have begun to stabilize over the past two years.
2. Short-term health insurance kept its stride.
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 them a more affordable insurance option for many.
Short-term health insurance remained a relevant health insurance option throughout the decade, despite renewed scrutiny. Short-term medical plan sales increased sharply after the ACA took full effect in 2014. And 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 policies 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.
3. High-deductible health plans grew in popularity.
High-deductible health plans were introduced in the early 2000s, but they were considered "mainstream plans" by 2012. In fact, HDHP enrollment jumped from 10 million people to 11.4 million people in one year (from January 2010 to January 2011).
People can obtain HDHP plans through their employer/group based plan (if offered), the healthcare exchange, or private insurers.
By 2015, HDHPs accounted for 60% to 80% of plans offered in the individual health insurance marketplace. In 2019, the IRS high-deductible health plan as any plan with a deductible of at least $1,350 for an individual and $2,700 for a family. The average annual deductible for individual coverage through a group plan was $1,655 in 2019.
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 and more employers beginning to offer additional coverage options once again.
4. Healthcare spending continues to climb.
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
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 seeking alternative healthcare through things like telemedicine.
5. An Opioid epidemic devastates our nation.
The opioid epidemic might be the most daunting and complex public health crisis of our time.
Heroin-related overdoses increased 286% from 2002 to 2013, with a significant spike around 2010. Another wave of opioid-related deaths hit around 2013 - this time, synthetic opioids like fentanyl were behind the surge. The crisis continued to escalate from there, with prescription drugs playing a significant role.
Opioid overdoses accounted for more than 42,000 deaths and increased to 47,600 people in 2017.
By 2019, more than 90 Americans per day were dying from opioid overdose. And prescription opioid abuse was costing the nation $78.5 billion per year.
The epidemic impacted people in both rural and urban environments. But overdose deaths in rural communities surpass deaths in urban settings.
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 healthcare debate continues
Discussions about healthcare reform and our healthcare landscape did not stop when the ACA was passed. Conversations about legal challenges continue to this day.
And, there has been proposed legislation to repeal and replace the ACA under the Trump administration. While no legislation has passed so far, new tax legislation did pass in December 2017, changing one key aspect of the ACA. Previously, you could be penalized for not having health insurance, but the Congress and President eliminated the mandate rule for all coverage beginning Jan. 1, 2019.
The 5th Circuit also recently ruled in Texas vs. United States that the individual mandate is unconstitutional. A Texas Judge will be deciding what, if any, of the ACA still stands. And it’s unclear if the case will head to the Supreme Court.
With 2020 being an election year, the future of healthcare in America stands at a crossroads:
Democrats remain divided on the best course of action moving forward. Their focus is on the expansion of health insurance coverage with tactics like Medicare for all, building on the ACA’s foundation, and rethinking the entire system.
Republicans do not have a healthcare plan in place. Should Trump be reelected, his administration would likely continue its efforts to dismantle the ACA and pass new legislation in its place.
What happens in November 2020 will no doubt influence how healthcare plays out over the next decade. We’ll continue to follow the trends and changes as well as their impacts on our nation.