Affordable Care Act's payment reforms- Statistics & Facts

The Affordable Care Act, signed into law in 2010, is a major health care reform in the United States. Aside from expanding health care access and coverage, the ACA also contains several provisions to reform the payment and delivery system of the United States. These provisions target the inefficiency and high cost of a predominantly fee-for-service system, and the inconsistent level of care patients receive from different providers or regions. The problem is that for the high amount the U.S. spends on health care – 20 percent of GDP – much higher than comparable high-income countries, Americans are not healthier. In fact, they perform worse on many health outcomes such as maternal mortality and treatable deaths. Americans do not actually use more health services, rather the high health spending in the U.S. is attributed to a multitude of other factors, such as higher health costs, higher physician charges, higher drug prices, and higher health administrative costs. Another area of health cost comes from wasteful health spending, particularly uncoordinated care or overtreatment. One of the ways to address this – to provide better care at lower cost – is to hold providers accountable for the quality and costs of care. Rather than rewarding the delivery of more services regardless of benefit to the patient, such is the trend under fee-for-service payments, the quality of care should instead be rewarded. To this end, the Center for Medicare & Medicaid (CMS) Innovation Center was created under the ACA to introduce and test innovative health care payment models.

Estimated wasteful health spending on overtreatment or low-value care in 2019: 101.2b USD

Gross federal savings from Accountable Care Organization in MSSP in 2020: 4.14b USD

Biggest problem facing the U.S. health system: Cost of accessing treatment

Editor’s Picks Current statistics on this topic

Share of adults aged 18-64 years with private health insurance in the United States from 2010 to 2022, by state Medicaid expansion status

Health System

U.S. adults with private health insurance by Medicaid expansion status 2010-2022

Share of adults aged 18-64 years with public health insurance in the United States from 2010 to 2022, by state Medicaid expansion status

Health System

U.S. adults with public health insurance by Medicaid expansion status 2010-2022

Median Medicaid income eligibility limits for children and adults as a percent of the Federal Poverty Level (FPL) as of January 1, 2023, by state expansion status

Public Health Programs

Medicaid income eligibility limits as % FPL as of Jan 2023, by state expansion status

Recommended statistics

Introduction: high uninsured rates before ACA

Basic Statistic Number of people in the U.S. without health insurance 1997-2021
Number of people in the U.S. without health insurance 1997-2021
Number of people without health insurance in the United States from 1997 to 2021 (in millions)
Premium Statistic Percentage of people in the U.S. without health insurance 1997-2021
Percentage of people in the U.S. without health insurance 1997-2021
Percentage of people without health insurance in the United States from 1997 to 2021
Premium Statistic Percentage of U.S. Americans with any health insurance 1990-2021
Percentage of U.S. Americans with any health insurance 1990-2021
Percentage of people with any health insurance in the United States from 1990 to 2021
Premium Statistic Share of people in the U.S. without health insurance by age 1997-2022
Share of people in the U.S. without health insurance by age 1997-2022
Share of people without health insurance in the United States from 1997 to 2022, by age
Premium Statistic Share of U.S. adults without health insurance by poverty level 1997-2022
Share of U.S. adults without health insurance by poverty level 1997-2022
Share of adults aged 18-64 years without health insurance in the United States from 1997 to 2022, by family income as a percentage of FPL

Current picture: Medicaid expansion vs non-expansion states

Premium Statistic Share of U.S. adults without health insurance by Medicaid expansion status 2010-2022
Share of U.S. adults without health insurance by Medicaid expansion status 2010-2022
Share of adults aged 18-64 years without health insurance in the United States from 2010 to 2022, by state Medicaid expansion status
Premium Statistic U.S. adults with public health insurance by Medicaid expansion status 2010-2022
U.S. adults with public health insurance by Medicaid expansion status 2010-2022
Share of adults aged 18-64 years with public health insurance in the United States from 2010 to 2022, by state Medicaid expansion status
Premium Statistic U.S. adults with private health insurance by Medicaid expansion status 2010-2022
U.S. adults with private health insurance by Medicaid expansion status 2010-2022
Share of adults aged 18-64 years with private health insurance in the United States from 2010 to 2022, by state Medicaid expansion status
Basic Statistic Uninsured U.S. children distribution and rate by Medicaid expansion status 2020
Uninsured U.S. children distribution and rate by Medicaid expansion status 2020
Distribution and rate of children without health insurance in the U.S. in 2020, by state Medicaid expansion status
Basic Statistic Medicaid income eligibility limits as % FPL as of Jan 2023, by state expansion status
Medicaid income eligibility limits as % FPL as of Jan 2023, by state expansion status
Median Medicaid income eligibility limits for children and adults as a percent of the Federal Poverty Level (FPL) as of January 1, 2023, by state expansion status

Current picture: areas of improvement

Basic Statistic Number of uninsured U.S. adults in the Medicaid coverage gap in 2019
Number of uninsured U.S. adults in the Medicaid coverage gap in 2019
Number of non-elderly uninsured adults in non-expansion states who would be eligible for Medicaid if their states expanded Medicaid as of 2019 (in thousands)
Basic Statistic Distribution of U.S. adults in the Medicaid coverage gap in 2021, by state
Distribution of U.S. adults in the Medicaid coverage gap in 2021, by state
Distribution of adults in the Medicaid coverage gap in the United States in 2021, by state
Basic Statistic Number of uninsured U.S. adults in the Medicaid coverage gap in 2019, by state
Number of uninsured U.S. adults in the Medicaid coverage gap in 2019, by state
Number of non-elderly uninsured adults in non-expansion states who would be eligible for Medicaid if their states expanded coverage as of 2019, by state and current eligibility
Basic Statistic Number of U.S. people in the 'family glitch' in 2019, by select demographics
Number of U.S. people in the 'family glitch' in 2019, by select demographics
Number of dependents that fall in the 'family glitch' in the U.S. in 2019, by insurance coverage, income, gender, and age (in thousands)
Basic Statistic Share of U.S. people in the 'family glitch' in 2019, by select demographics
Share of U.S. people in the 'family glitch' in 2019, by select demographics
Percentage of dependents that fall in the 'family glitch' in the U.S. in 2019, by insurance coverage, income, gender, and age
Basic Statistic American Rescue Plan removes ACA subsidy cliff for two years starting 2021
American Rescue Plan removes ACA subsidy cliff for two years starting 2021
ACA subsidy cliff: health insurance premiums as percent of income among U.S. adults of 60 years with average Silver Plan under the ACA vs COVID-19 Relief Law in 2021

Positive impact of ACA

Basic Statistic Number of studies that find positive effects of Medicaid expansion as of 2021
Number of studies that find positive effects of Medicaid expansion as of 2021
Number of studies on the effects of ACA Medicaid expansion on select outcomes in the U.S. published between Jan. 2014 and Mar. 2021, by study finding
Basic Statistic Number of ACA-related enrollments in the U.S. 2014-2021
Number of ACA-related enrollments in the U.S. 2014-2021
Number of Affordable Care Act-related (ACA) enrollments in the Marketplace, Medicaid, and the Basic Health Program (BHP) in the U.S. from 2014 to 2021
Basic Statistic Impact of Medicaid expansion on mortality in the U.S. 2014-2017
Impact of Medicaid expansion on mortality in the U.S. 2014-2017
Cumulative impact of Medicaid expansion on mortality among older adults in the U.S. from 2014 to 2017
Basic Statistic Impact of Medicaid expansion on mortality in the U.S. 2014-2017, by state
Impact of Medicaid expansion on mortality in the U.S. 2014-2017, by state
Cumulative impact of Medicaid expansion on mortality among older adults in the U.S. from 2014 to 2017, by state
Basic Statistic Traditional Medicaid savings from Medicaid expansion in select U.S. states as of 2020
Traditional Medicaid savings from Medicaid expansion in select U.S. states as of 2020
Estimated savings to traditional Medicaid from Medicaid expansion for select U.S. states and years, as of 2020

Payment & delivery reform: Accountable Care Organizations

Premium Statistic Number of ACOs in Medicare Shared Savings Program 2012-2023
Number of ACOs in Medicare Shared Savings Program 2012-2023
Number of Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program in the United States from 2012/2013 to 2023
Premium Statistic Number of beneficiaries assigned to ACOs in Medicare Shared Savings Program 2012-2022
Number of beneficiaries assigned to ACOs in Medicare Shared Savings Program 2012-2022
Number of beneficiaries assigned to Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program in the United States from 2012/2013 to 2022 (in millions)
Basic Statistic Number of ACO participants in Medicare Shared Savings Program 2023
Number of ACO participants in Medicare Shared Savings Program 2023
Number of Accountable Care Organization (ACO) participants in the Medicare Shared Savings Program (MSSP) in the U.S. as of January 2023
Premium Statistic Earned savings of ACOs in Medicare Shared Savings Program 2012-2021
Earned savings of ACOs in Medicare Shared Savings Program 2012-2021
Total earned shared savings of Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program (MSSP) in the U.S. from 2012 to 2021 (in million U.S. dollars)
Premium Statistic Gross federal savings from ACOs in Medicare Shared Savings Program 2013-2020
Gross federal savings from ACOs in Medicare Shared Savings Program 2013-2020
Gross federal savings from Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program (MSSP) in the U.S. from 2013 to 2020 (in million U.S. dollars)
Basic Statistic Overall quality scores of ACOs in Medicare Shared Savings Program 2012-2021
Overall quality scores of ACOs in Medicare Shared Savings Program 2012-2021
Average overall quality score of Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program (MSSP) in the U.S. from 2012 to 2021

Payment & delivery reform: HRRP & HACRP

Basic Statistic Number of U.S. hospitals Medicare punished for high readmissions in FY 2023
Number of U.S. hospitals Medicare punished for high readmissions in FY 2023
Number of hospitals in the United States that Medicare punished in FY 2023 for high readmission
Basic Statistic Number of U.S. hospitals Medicare punished for high readmissions FY2022, by years
Number of U.S. hospitals Medicare punished for high readmissions FY2022, by years
Number of acute-care hospitals in the United States that Medicare punished for high readmission as of FY2022, by the number of years punished
Basic Statistic Number of U.S. hospitals Medicare punished for high readmissions FY 2015-2023
Number of U.S. hospitals Medicare punished for high readmissions FY 2015-2023
Number of hospitals in the United States that Medicare punished for high readmission from FY2015 to FY2023
Basic Statistic U.S. hospitals Medicare punished for high hospital-acquired conditions FY 2015-2022
U.S. hospitals Medicare punished for high hospital-acquired conditions FY 2015-2022
Number of hospitals in the United States that Medicare punished for high rates of hospital-acquired conditions (HAC) from FY2015 to FY2022

Public opinion

Basic Statistic U.S. opinion on the ACA April 2010-March 2023
U.S. opinion on the ACA April 2010-March 2023
Percentage of public with favorable or unfavorable opinion of the Affordable Care Act (ACA) from April 2010 to March 2023
Premium Statistic Share of U.S. adults who approved or disapproved of ACA in 2020, by party
Share of U.S. adults who approved or disapproved of ACA in 2020, by party
Percentage of U.S. adults who approved or disapproved of the Affordable Care Act (ACA) and said whether changes were needed in 2020, by party identification
Basic Statistic U.S. public opinion: overturning ACA/Obamacare 2020, by party
U.S. public opinion: overturning ACA/Obamacare 2020, by party
Public support and opposition for overturning the Affordable Care Act (ACA/Obamacare) in the U.S. in 2020, by party affiliation
Basic Statistic U.S. public opinion: overturning ACA's pre-existing condition protection 2020
U.S. public opinion: overturning ACA's pre-existing condition protection 2020
Public support and opposition for overturning the Affordable Care Act's (ACA's) protections for people with pre-existing conditions in the U.S. in 2020, by party affiliation
Basic Statistic Public opinion on intentions of health care plans U.S. January 2020
Public opinion on intentions of health care plans U.S. January 2020
Opinion on cost and coverage goals of Medicare-for-all, public option, and the Affordable Care Act as of January 2020

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Key figures

The most important key figures provide you with a compact summary of the topic of "Obamacare's payment reforms" and take you straight to the corresponding statistics.

Number of ACOs in the Medicare Shared Savings Program in 2023
456
Detailed statistics
Number of ACOs in Medicare Shared Savings Program 2012-2023
Number of beneficiaries assigned to ACOs in the MSSP in 2023
10.9m
Detailed statistics
Number of beneficiaries assigned to ACOs in Medicare Shared Savings Program 2012-2022
Average quality score of ACOs in the MSSP in 2021
91%
Detailed statistics
Overall quality scores of ACOs in Medicare Shared Savings Program 2012-2021