HHS Secretary Sylvia Burwell Says Affordable Care Act Is Working

“Taken together I believe the evidence points to a clear conclusion: the Affordable Care Act is working,” said Health and Human Services Secretary Sylvia Burwell today during an event hosted by the Engelberg Center for Health Care Reform at Brookings. The event marked nearly one year since the launch of, the online health insurance marketplace created by the Affordable Care Act (ACA).


Secretary Burwell focused on continued implementation of the law, noting both successes and remedies for challenges that remain, and laid out three basic measures of judging how the ACA is working: access, affordability, and quality.

“During the last open enrollment,” she said, “consumers choose from an average of nearly 50 plans” adding that in 2015, we can expect “a 25 percent increase in the total number of issuers selling insurance in the marketplace.” Secretary Burwell also noted previously-announced numbers on enrollment: an additional 7.3 million enrollees have signed up for marketplace plans; and another 8 million have gained coverage through Medicaid or the Children’s Health Insurance Program (CHIP). Collectively, this sweeping expansion in coverage has contributed to a 26 percent decline in the uninsured rate, which the secretary deemed “the most important number,” representing “historic progress on something that has eluded our country for over a century.”

On the metric of affordability, Secretary Burwell cited evidence that “nearly 70 percent of Americans in market insurance plans now feel they can afford their care,” while seniors have saved $11.5 billion on prescriptions after the phase-out of the “donut hole” in prescription drug coverage. Also there is “evidence that we have bent the cost curve” on health care and held down price inflation.

In terms of quality, Secretary Burwell noted that insurance companies are now required by the ACA to spend at least 80 percent of customers’ premiums on health insurance and cited a number of instances where barriers to care such as pre-existing conditions, over-utilization of emergency rooms, and high costs have contributed to poor health outcomes for many Americans. 

As a new open enrollment and renewal period approaches, Secretary Burwell laid out  a four-part strategy moving forward:

  1. Improving access and affordability through the marketplace. “In order to make sure that Americans continue to get access and affordable choices, we have to get right. To me the formula for this is technology, management, and prioritization. We’re checking off the outstanding items from last year’s to do list, cleaning up back end functionality, and adding functionality for renewing and enrolling in coverage. … We’re focusing on giving ourselves the appropriate amount of time for testing and we’re very focused on security.”
  2. Improving quality for patients and spending dollars wisely. “We’re testing new models in Medicare and Medicaid, and reaching out to the business community to find solutions that we can all benefit from; changing incentives to move from volume-based to more impact-based system; investing in tools that can expand our capacity for change in the health care delivery system; [and] improving the flow of information so doctors can spend more time with patients and less time doing paperwork and so they can coordinate more effectively with one another.”
  3. Expanding access by expanding Medicaid. The secretary observed that since she has taken office, Pennsylvania, with a Republican governor, has been added.
  4. Helping consumers understand how to use their new coverage, including the role of prevention and wellness. “Many of the folks who are newly covered haven’t had health insurance in years and some of them even never before. We want to make sure folks know how to use their coverage and we’re partnering with organizations across the country to help them do so.”

In conclusion, Secretary Burwell asked for a “course correction when it comes to talking about these issues.” It starts, she said, “with collectively turning the volume down.”

Learn more and get video and audio from the event’s page.