7 Things You Didn't Know Obamacare Has Done

With Obamacare on Republican lawmakers' chopping block, many provisions and effects of the previous president's health care law hang in the balance.

Many of the law's effects are well known: its creation of health insurance marketplaces, the expansion of Medicaid, the mandate to buy health insurance, its protection of patients with preexisting conditions, the millions of people who gained insurance under the law and the fact that for many people insurance remains out of reach.

But the Affordable Care Act is a long, complicated law with many aims and moving parts. Here are seven effects of the health care law you may not not have heard about:

1. Increased access to birth control

While debates about the law's mandate that all insurance plans cover birth control have been widely debated, the results of this provision were somewhat less reported: The number of women consistently taking birth control pills appears to have increased since the law was passed.

Some researchers believe increased access to birth control contributed to the recent decline in the abortion rate, though a recent wave of restrictions on abortion was also a likely factor.

2. Eliminated lifetime limits on health insurance coverage

Before the passage of the health care law, insurance plans could place annual and lifetime limits on the amount of health care spending they would cover. That meant that if you reached the maximum annual limit within the year, or your lifetime limit, your insurer could legally refuse to cover any further costs you might incur.

People who suddenly found themselves very ill or needing extensive health care services could end up blowing through their spending limits, and they would be personally be responsible for covering the rest of the potentially exorbitant bill.

Now, under ACA-compliant plans, which include nearly all employer-based and marketplace-purchased insurance, no such limits are placed on necessary health care spending.

3. Offered refundable tax credits to help cover health care costs

One of the central features of Obamacare is the individual marketplace, where people without other options for health insurance can purchase plans. Because these plans are often expensive, the law offers subsidies in the form of refundable tax credits that provide more help to people with lower incomes.

The subsidies are a widely known part of the law, but they're mentioned here because House Speaker Paul Ryan, a key critic of the law, said in a recent interview that he would like to replace the Obamacare subsidies with a refundable tax credit. The only problem with this plan is that, as was just mentioned, Obamacare's subsidies are refundable tax credits.

So if Paul Ryan doesn't know that the subsidies are tax credits, many other people probably don't know that either.

4. Lowered projections of the deficit

Despite much of the criticism President Obama received for the federal deficits under his administration, the Congressional Budget Office actually found that the health care law in its entirety would help to reduce the deficit over the long run. Though projections are not gospel and could end up being mistaken, so far the program has cost less than expected — though it has also enrolled many fewer people in the marketplaces than originally hoped.

Critics of the law point out that a key feature of the law known as the "Cadillac tax," which levies a tax on the most expensive health care plans, plays a central role in preventing the law from raising the deficit.

But the Cadillac tax is very unpopular and has already been delayed. If it is never fully implemented, the health care law would struggle to cover its own costs.

5. Required restaurant and vending machine calorie labels

In an effort to promote not just health insurance but health, Obamacare included a provision creating nationwide calorie-labeling requirements for certain types of restaurants and vending machines. This provision, like the Cadillac tax, has faced delays in implementation.

The idea is simple: If you give people more information about their food, they can make healthier choices. However, most studies done so far on this intervention have found little evidence that it makes a difference.

6. Reduced support for government health care spending — at first

A study in September 2015 found that passage of the Affordable Care Act appeared to reduce support for increasing federal spending on health care among Republicans, Democrats and Independents. The levels of support started pretty high, around 86 percent supporting higher spending among Democrats and two-thirds for Republicans; but these fell by 12 percent and 25 percent after the law passed in 2010, respectively.

“One would expect strongly partisan responses to the passage of Obamacare,” said Stephen Morgan, one of the researchers who worked on the study. “But the decline in support is from everyone. Our conclusion is that a conservative cold front may have arrived in 2010, fueled by the passage of the ACA.”

Ironically, support for the law has reached an all-time high among Americans according to a recent poll, just a few months after a president was elected who promised to repeal it.

7. Thousands of lives saved

Though no precise number is known, multiple sources of evidence suggest that many thousands of lives have been saved because of Obamacare. A report from the Agency for Healthcare Research and Quality found that the law's efforts to reduce hospital-acquired conditions saved around 50,000 lives from 2010 to 2013.

Another study published in Health Affairs found that thousands of lives were saved by the law's provision of free colorectal cancer screenings, once of the deadliest cancers. And yet another study found that Medicaid expansion reduced mortality rates among the vulnerable population, which researchers suggest could mean more than 40,000 lives saved a year.

While none of these results are definitive or precise, the bulk of the evidence suggests that a very substantial number of lives were saved by law, likely numbering in the tens of thousands.

Photo credit: Official White House Photo by Chuck Kennedy