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The Affordable Care Act at 5 Years

smiling doc and patient


Just over five years ago, the Affordable Care Act was signed into law. While it is too soon to fully assess the law’s effects, a Health Policy Report in the New England Journal of Medicine by The Commonwealth Fund’s David Blumenthal, M.D., Melinda Abrams, and Rachel Nuzum reflects on the ACA’s initial impact on Americans and the nation’s health system.

The article focuses on the law’s two main sets of provisions: the expansion of health insurance and other coverage reforms, and changes to the delivery system, with particular emphasis on the latter.

Availability and Affordability of Insurance and Access to Care

  • The estimated number of uninsured individuals who have gained coverage since 2010 ranges from 7 million to 16.4 million. Overall, more than 30 million Americans—including some who previously had insurance—now have insurance under the new sources of coverage and consumer protections provided by the Affordable Care Act.
  • Surveys show that the newly insured are pleased with their coverage, and that fewer Americans are reporting problems with medical bills and financial barriers to care.

Improvements to Health Care Delivery

  • Hospitals with higher-than-expected Medicare readmissions within 30 days are now subject to financial penalties. Since 2012, these readmission rates have declined nationally by more than a percentage point, translating to about 150,000 fewer readmissions annually.
  • Overall rates of hospital-acquired conditions, like avoidable infections or adverse drug events, declined for the first time ever, following the ACA’s imposition of financial penalties for high rates of these conditions among Medicare patients.
  • Under provisions of the ACA, providers are forming accountable care organizations, or ACOs. These entities seek to promote coordination of care and take responsibility for the cost and quality of care provided to a defined patient population. Early evaluation of two Medicare ACO programs indicates they have achieved about $900 million in savings.
  • The ACA required all state Medicaid programs to pay primary care physicians at Medicare rates—a considerable increase in some states—for two years. A study of 10 states showed a subsequent increase in the availability of appointments for Medicaid patients.


While it is premature to draw firm conclusions about the cost and quality effects of the ACA, the law has significantly improved access to affordable health insurance.

Read the article.

Publication Details



D. Blumenthal, M. K. Abrams, and R. Nuzum, “The Affordable Care Act at 5 Years,” New England Journal of Medicine Online First, May 6, 2015.