What to Look for in Judging the Affordable Care Act

A year in, how’s the Affordable Care Act doing? That’s the question a team of Times reporters has examined in a series of stories and charts running today.

Next month, the Affordable Care Act’s second year of open enrollment will begin, and with it an appropriate focus on the operational performance of Healthcare.gov and state marketplaces. But over the long term, the law will be judged not on whether its computer systems were buggy but whether it delivered on its key promises to make health care more available and affordable for individuals and the government.

Here are some of the key questions I’ll be asking in the next year and years ahead: Are more people getting health insurance? Is the coverage affordable and useful to people? Is public health improving? Are people experiencing less medical debt and bankruptcies? Are the marketplaces working? Are health care companies surviving? Is health care spending growing at a sustainable rate — for the economy and the federal budget?

In many frustrating ways, it’s still early to deliver clear judgments on all of these questions. But the data have already provided some preliminary answers. The number of Americans without insurance has declined. The insurance marketplaces are largely functioning, with consumers choosing from competing health plans. Health care industries, as a group, look to be thriving in the new environment, though there are clearly winners and losers in the reshaped markets for insurance and medical care. The rate of growth in health care spending has moderated — though the Affordable Care Act is at best a bit player in that welcome development.

There’s a lot we still don’t know. Principally, there’s no good way (yet) to measure the law’s impact on the public’s actual health. It’s still too soon to know the law’s effect on Americans’ financial security. And there are still many eligible people who are not availing themselves of the law’s new benefits, either because of a lack of knowledge, an inability to afford insurance, political opposition to the law or individual states’ decisions not to expand Medicaid to their low-income residents. (The package includes a series of profiles of individuals who interacted with the law — some in these categories, some who are delighted by their new insurance coverage, and others who welcome it with reservations.)

The stories today reflect what we can measure now. There will be new useful data in the months ahead. In early November, we’ll know the prices of health plans and the number of competitors in every market in the country. That will tell us a lot more about how well the marketplaces are functioning. In a few months, we’ll get government surveys that tell us with much more precision who exactly got insurance in the Affordable Care Act’s first year and what kind of insurance they bought. The year ahead will also tell us more about what’s happening in the employer insurance market, where new rules are coming online in January, and surveys will begin to capture how the first year of the marketplace changed companies’ behavior.

My colleague Abby Goodnough predicts smoother sailing for the exchange websites this time around, compared with last year’s problematic launch. But there is inevitable turbulence ahead that is likely to generate a lot of attention, even if it matters little beyond the short term. Over the long term, keep your eye on these larger questions about the Affordable Care Act’s performance. They will tell you more about whether the law has been well designed and is offering the country what it wants and needs.