Five years after the passage of ObamaCare, the impact of the law on the nation’s healthcare system is beginning to come into focus.
There is still plenty of uncertainty about the law's long-term effects, with key provisions — most notably the employer mandate to provide insurance — not yet in effect.
But new data is providing an early glimpse of how President Obama’s signature law is reshaping the healthcare marketplace, with millions of people added to the insurance rolls and a slew of new regulatory requirements now in effect.
"For us, everything has changed," said Clare Krusing, spokeswoman for the trade group, America's Health Insurance Plans.
The success of the law is the subject of fierce debate between the two parties. While one of the White House's favorite lines is "the Affordable Care Act is working," Republicans say the law is an unmitigated disaster that should be repealed.
Here are the some of the most tangible changes resulting from ObamaCare so far.
17 million people newly insured
Nearly 22.8 million people have purchased insurance through ObamaCare, according to a national study by RAND Corp. released earlier this month, with 17 million enrolling in a plan for first time.
The figures put the Obama administration on track to meet its goal of reducing the uninsured population by 19 million in 2015, with another two months left for new sign-ups this year.
The biggest groups of enrollees have been young people between the ages of 18 and 34; blacks; Hispanics; and people living in poorer and rural areas, according to recent data from an analysis by Enroll America and Civis.
Much of the expansion can be credited to ObamaCare tax subsidies, which about 80 percent of customers qualify for. So far, more than $10 billion has gone out to help people afford their care.
Upticks in premiums
Premium prices for health insurance are increasing, though unevenly, across states.
The insurance industry is adjusting to hundreds of new ObamaCare regulations, including the minimum benefit requirements and the ban on rejecting people with pre-existing conditions.
On the whole, the new requirements have made coverage more expensive, experts say.
As this year’s rating season begins, the biggest insurers in several states — including New Mexico, Tennessee and Maryland — have proposed rate hikes all exceeding 25 percent. All have cited the costs of covering people under ObamaCare.
Still, Krusing, from the health insurers trade group, argues that it’s almost impossible to make a blanket statement that ObamaCare is driving up premiums across the board.
“It's more complex than that,” she said, pointing to the rising cost of prescription drugs and the increased number of provider consolidations, which decreases competition.
“If you want to understand the premium story, you have to look at factors and local dynamics,” she said.
$7.4 billion decrease in uncompensated hospital costs
Nationwide, hospitals are noticing “palpable” changes in payments, patient safety and reimbursements, according to Chip Kahn, president and CEO for Federation of American Hospitals.
He pointed specifically to the decrease in charity care — healthcare costs that are not reimbursed by the government — because of the drop in the uninsured population.
Uncompensated care dropped by one-fifth nationwide in 2014, according to a government report released in March.
“There’s a big shift,” Kahn said.
Hospital readmissions are also decreasing gradually as the Obama administration increases penalties each year.
The government recently fined a record 2,610 hospitals for readmitting too many people within a month of treatment. And the penalties will keep increasing, which Kahn said is pushing executives to pay more attention to the post-hospitalization phase of care.
“It’s pretty apparent that the penalty for readmission has also had a major effect,” he said.
30 states with expanded Medicaid
The biggest factor in determining whether a person gained insurance under ObamaCare is their Zip code.
About 12 million people became are newly eligible for Medicaid, the government’s insurance program for the disabled and the elderly, according to a study this month. Under ObamaCare, people are allowed to sign up if their income is up to 138 percent of the poverty line — about $33,000 for a family of four.
But many Republican-led states have rejected the expansion, raising alarms about federal overreach and skyrocketing costs.
New data from the Obama administration shows that Medicaid enrollment grew by almost 27 percent in the expansion states, compared to 8 percent in non-expansion states.
In many of the states rejecting the expansion, uninsured rates remain high. Across the South between Texas and Virginia, hundreds of counties have uninsured rates at or exceeding 16 percent.
One-quarter of people 'underinsured'
Health policy groups are increasingly voicing concern about the large number of people who are struggling with healthcare costs and falling behind on bills despite having insurance.
Rising deductibles and co-pays are deterring many people from seeking care, observers say.
One-quarter of people with health insurance are paying so much in deductibles and out-of-pocket expenses, they are considered “underinsured,” according to a study this month by the Commonwealth Fund.
Those costs are piling up. Nearly one in four Americans report holding some medical debt, and nearly all have health insurance.
Just over 40 percent of privately insured adults with deductibles of $1,000 or higher were paying off accumulated medical bills of $4,000 or more, according to a separate report from the Commonwealth Fund this month.
“All across the country, Americans are struggling under the costs of health care, under this healthcare law,” Sen. John BarrassoJohn Anthony BarrassoWatch: GOP leaders discuss Biden's first year in office McConnell will run for another term as leader despite Trump's attacks Senate Minority Whip Thune, close McConnell ally, to run for reelection MORE (R-Wyo.) said, citing the study.