The ACA remained squarely in the crosshairs in the early maneuverings for the 2016 presidential nominations. Republican candidates continued to promise to repeal and replace the law if their party wins the White House and holds onto both houses of Congress next fall. Democratic presidential candidate Hillary Clinton proposed significant ACA changes to improve affordability.
Obamacare continued to receive tepid public support even though the nation's uninsured rate hit a record low, largely due to the law's coverage expansions. A Centers for Disease Control and Prevention survey found that only 9% of Americans, or 28.5 million people, lacked coverage as of June, down from 16% in 2010 when the law was enacted.
“This has been tremendous progress,” said Larry Levitt, a senior vice president at the Kaiser Family Foundation. “The question now is will it go lower?”
Expanded coverage came at a price. Total healthcare spending during 2015 grew faster than it had since the start of the Great Recession. The faster growth rate prompted fears of a return to high medical inflation. “It's absolutely no surprise” that spending went up because more people were insured, said Paul Ginsburg, a University of Southern California health economist. “The purpose of covering them was allowing them to use more services.”
However, the rate of increase began to moderate over the course of the year. Some experts noted the proliferation of high-deductible health plans was forcing some consumers to limit their medical utilization.
Healthcare providers enjoyed considerable balance sheet relief in 2015 as they saw fewer uninsured patients. For most, revenue growth outpaced expenses. The financial improvement led credit-rating agencies to raise the overall outlook for not-for-profit hospitals from negative to stable.
Enticed by low rates, healthcare borrowing increased in 2015 after reaching the lowest level in more than a decade the prior year. Most of that money was earmarked to refinance older debt rather than for new capital expenditures. A number of health systems returned to bond-financed building projects. “There are still larger institutions that have new towers in mind,” said Colleen Mullaney, who heads TD Bank's Southern healthcare division.