The failure of the US Congress to repeal and replace the Affordable Care Act (ACA) in March illustrated an important problem in the way that politicians are thinking about healthcare. Politics should not determine how we care for people in need. Rather than trying to accommodate our healthcare system to a political ideology—whether it is capitalism, socialism, or libertarianism—we should start with what the patient needs and build from there.
The patient is not in the center of the maze we call the ACA. The patient is off to one side and the physician is off to the other side. Despite their protests about expensive risk pools in the ACA exchanges, the five biggest US health insurers have done well since the act was implemented. Collectively, their annual profits went up 17%, from $12.8 billion in 2013 to $14.6 billion in 2016.[1,2,3,4,5,6,7,8,9] That $1.8 billion profit was lifted from the pockets of patients and providers.
Table. Change in Top 5 Health Insurers' Profits Under the ACA, in Billions of Dollars
| Insurers | 2013 | 2016 | % Change |
|---|---|---|---|
| UnitedHealth | $5.67[1] | $7.29[2] | 39 |
| Anthem | $2.49[3] | $2.47[3] | -1 |
| Aetna | $1.91[4] | $2.30[5] | 23 |
| Cigna | $1.48[6] | $1.90[7] | 36 |
| Humana | $1.23[8] | $0.61[9] | -127 |
| TOTALS | $12.79 | $14.58 | 17 |
What did the consumer get?
