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The Affordable Care Act: What Are the Facts After Five Years?


The Affordable Care Act (ACA) has been one of the most controversial pieces of social legislation enacted in recent history. Much of the debate, however, has been partisan and ideological in nature. A considered discussion of the law’s successes and failures to date is long overdue.

In a new collection of publications, The Commonwealth Fund looks at whether, after five years, the ACA is meeting its aim of expanding affordable health care coverage—and improving the functioning of our health insurance and health care system. While the law’s coverage expansions have been widely followed, few critics, or even supporters, are aware that the ACA constitutes the nation’s largest effort so far to improve quality of care and contain costs. It is this combination of coverage and delivery system reforms that, if successful, will help bring about a sustainable health system that works well for everyone.

We know the law has had a considerable impact on the availability of health insurance. More than 25 million people are now estimated to have health insurance under its various provisions. Because of the Supreme Court’s unexpected ruling that made Medicaid expansion a state choice, drops in uninsured rates diverge greatly across the country, with rates falling to the lowest levels in states that have expanded Medicaid eligibility. All told, as many as 16.4 million previously uninsured people have gained coverage since the law passed in 2010.

But our new publications also point to signs that the law is starting to change the way care is paid for and delivered to patients. A newly released Fund report on the ACA focuses on three broad areas: testing new models of care and spreading successful ones, encouraging the shift toward payment based on the value of care provided, and developing resources for systemwide improvement. For example, the law contains provisions that support the spread of accountable care organizations and medical homes and that strengthen primary care. Additionally, the Center for Medicare and Medicaid Innovation, created by the law, is testing an array of changes to how health care providers are organized and paid that together are affecting thousands of hospitals, 60,000 clinicians, and 2.5 million patients across all 50 states.

While health spending growth has slowed in recent years, and there are signs—such as falling rates of hospital-acquired infections—that care is improving, we can’t yet comment definitively on the impact of the law’s delivery reforms. But we offer some promising examples.

To learn more about how the Affordable Care Act is changing the face of U.S. health care, I encourage you to read:

It is time to let the facts guide our discussions of the future of the Affordable Care Act.

Publication Details



David Blumenthal, Former President, The Commonwealth Fund

[email protected]


D. Blumenthal, "The Affordable Care Act: What Are the Facts After Five Years?" The Commonwealth Fund Blog, May 7, 2015.