It’s been more than six years since the Affordable Care Act (ACA) went into effect, so it’s time to ask the question: Is it working?

The answer depends on who you ask.

Polls conducted by Gallup and the Kaiser Family Foundation both show that public opinion is about evenly split – often down political lines with Democrats supporting the ACA and Republications against it.

The government isn’t shy about promoting successes.

In July, U.S. health chief Sylvia Burwell touted the ACA’s success in Cleveland by highlighting a program that helped people with diabetes control their disease cut costs by $2,600 per individual. The program, which was funded through the office of innovation at the Centers for Medicare and Medicaid Services, used lifestyle coaches to help participants change their eating habits and increase their activity levels.

The U.S. Department of Health & Human Services also touted several accomplishments at the 5-year mark including:

  • 4 million people added health coverage through a combination of the Health Insurance Marketplace, extended eligibility for young adults (to age 26), and Medicaid expansions.
  • 55 million women have preventive services coverage with no out-of-pocket costs.
  • Uncompensated care in hospitals was reduced by $7.4 billion.
  • In 2015, nearly 80% of shoppers using gov could buy coverage for $100 or less after tax credits.
  • There’s been a slow-down in health care inflation.
  • Patient safety has improved, saving an estimated 50,000 lives and $12 billion.
  • Accountable Care Organizations have saved Medicare a combined $417 million.

Researchers at Rice University in Texas confirmed that the ACA has helped more Texans acquire health insurance at every age, ethnic and income level across the state. Premium subsidies are key: Today 84% of the 1.3 million Texans enrolled in the ACA Marketplace health plans receive subsidies to help pay for premiums.

The flip side

Of course, not everyone agrees that “Obamacare” is working. Critics note several flaws and weaknesses:

  • More than two-thirds of employers favor repeal of the Affordable Care Act’s employer mandate, according to Mercer’s 2015 National Survey of Employer-Sponsored Health Plans. The main issue: The prohibitive cost and administrative burden of showing they are in compliance.
  • Out-of-pocket health care costs for people with employer-sponsored insurance went up, according to a report by the Kaiser Family Foundation.
  • People are falling into holes in coverage according to “Uncovered California,” a Huffington Post series exploring the problems faced by millions of Californians who are uninsured or underinsured.
  • High premium surcharges for smokers have backfired, according to a Yale School of Public Health report released in July. Many smokers are opting out of coverage instead of quitting tobacco, which was the intention of the plan.
  • Federal coverage mandates rankled employers. Among the most significant was Hobby Lobby’s objection to providing contraceptive insurance coverage. This case made it to the Supreme Court, with a 5-4 decision that rejected the contraceptive mandate for family-owned companies that have religious objections.

With the presidential election just around the corner, health care remains a key topic of debate. Undoubtedly more change is on the horizon.

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