Shortly before the election the increases in the average premium costs under the ACA captured national attention.  Premiums rose on average by more than 20 percent with increases ranging from 145 percent in Arizona ($507 per month) to a low of – 4 percent in Indiana ($286 per month).  But all the focus was on the monthly insurance premiums and only the premiums of policies sold through the exchange markets set up under the ACA.  The real number to focus on for the upcoming debate is on the total cost of health care.  The Hill, a Capitol Hill publication reported last Friday, December 2, that total national spending on health care increased 5.8 percent to $3.2 trillion in 2015.  That is up from $3 trillion in 2014 (their source was a report from Health Affairs).  That breaks out to nearly $10,000 per person, the report found. The increased spending were due largely to an increase in health insurance coverage and expanded Medicaid coverage under the ACA and less due to increasing health care costs.

The ACA impact is two-fold: there is increased use of medical care as access expands but at the very same time the price of medical services –actual cost of health care—continued to grow at historically low rates, increasing only by 1.2 percent per person (according to the same Hill report). That has been consistent with other data that shows the rate of inflation for health care costs at historically low rates since the ACA was enacted.

It is not clear how much of reduced health care costs are directly tied to the ACA but the reality is that debates regarding savings within health care must deal with hundreds of billions or trillions of dollars.  For example, certain to come up are proposals to limit medical malpractice lawsuits as a saver of costs and a way to expand health insurance coverage by reducing premiums and costs.

In the past Republicans, have promoted enactment of medical malpractice reforms as a way to significantly save on health care costs.  Such proposals were scored by the Congressional Budget Office (CBO) in 2009 as saving $54 billion over ten years.  A large amount but that figure pales in comparison to health care costs that would likely total more than $32 trillion the same period.