HOW MUCH HAS HEALTH CARE GONE UP SINCE OBAMA CARE STARTED
Executive summary
Since the Affordable Care Act (ACA) was signed in 2010, overall U.S. health spending and many price lines have continued to climb, but the rate of growth slowed in the decade after the law’s passage compared with the decade before it; per‑person health spending rose from about $11,150 in 2010 to roughly $14,500 by 2023 in 2023 dollars [1] [2]. Studies and federal analysts find that annual growth rates in total and per‑capita spending were lower in the 2010s than the 2000s, even as individual‑market premiums and some out‑of‑pocket costs showed mixed trends depending on timeframe and product [3] [1] [4].
1. The headline numbers: spending per person and annual growth
Measured in inflation‑adjusted dollars, national health spending per person increased from about $11,150 in 2010 to about $14,500 in 2023, reflecting substantial absolute increases in spending even as annual growth rates moderated at times [1] [2]. Multiple authoritative analysts show that average annual growth in per‑capita spending slowed after 2010: for example, per‑capita spending growth averaged roughly 3.6% annually in 2010–2018 versus higher growth in prior decades, and the decade‑long slowdown in spending growth is documented in Health Affairs and CMS analyses [3] [5].
2. Out‑of‑pocket costs and the mixed picture for consumers
Out‑of‑pocket (OOP) expenses present a more complicated story: a JAMA analysis found OOP health expenses rose at an average annual rate of 3.4% from 2000–2009 but only 1.9% a year from 2010–2018, while component‑level shifts occurred—prescription OOP declined rapidly post‑2010 even as some physician service OOP rose due to out‑of‑network billing [1] [6] [7]. That heterogeneity helps explain why many consumers feel costs have increased sharply even while aggregate growth slowed: specific services, deductibles, and marketplace plan premiums can move differently than overall per‑capita spending [6] [8].
3. The individual market and contested premium changes
The individual (non‑group) insurance market saw sharp, concentrated changes around ACA implementation: some studies and conservative analysts argue premiums rose substantially for many who previously bought off‑market plans, with reports of double‑digit jumps in early years, while U.S. Health and Human Services and nonpartisan reviews conclude the ACA contributed to a slowdown in premium growth in subsequent years and increased transparency around rate filings [9] [10] [4]. Academics and policy shops note that short‑term premium shocks in 2013–2014 were followed by more moderate increases, and that isolating the ACA’s causal effect is difficult because of concurrent trends like the Great Recession and changing insurer participation [10] [3] [4].
4. Macro forces, other drivers, and what can’t be pinned exclusively on the ACA
Experts emphasize that the post‑2010 slowdown in spending growth cannot be solely attributed to the ACA; macroeconomic factors (lower inflation in parts of the 2010s), changes in provider payment, competitive exchanges, and secular trends such as technological change all play roles—and some studies explicitly say no paper conclusively links the ACA to increased spending growth [1] [5] [11] [3]. Health system trackers note spending volatility accelerated again in 2022–2023 (spending growth in 2023 exceeded 2010s averages), underscoring that annual results reflect broader economic and sectoral dynamics beyond the ACA alone [2].
5. Bottom line and areas of continuing debate
Bottom line: health care spending per person is notably higher than in 2010 in absolute terms, but average annual growth slowed in much of the 2010s compared with the 2000s, and scholarly and government analyses generally find the ACA helped dent the growth curve even though it did not reverse long‑term spending increases [1] [3] [5]. Significant debate remains about distributional impacts—who saw premiums fall or rise, how OOP burdens shifted by service type, and how temporary policy choices (for example, subsidies) will affect future affordability—so assessments depend on which metric (total spending, per‑capita growth, premiums, or OOP) is used [6] [4] [2].