The Future of the Affordable Care Act

Butler, Stuart M.

doi:10.1001/jama.2016.9881

Cited by 21 publications

(21 citation statements)

References 1 publication

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“…Health care coverage for the elderly and indigent with the passage of Medicare and Medicaid in T he enactment in 2010 of the Affordable Care Act (ACA), also known as Obamacare, was the most monumental change in US health care policy since the passage of Medicaid and Medicare in 1965 (1)(2)(3)(4). The ACA, despite its complexity, was enacted with 3 primary goals: increasing the number of insured, improving the quality of care, and controlling health care costs (2)(3)(4)(5)(6)(7)(8)(9)(10). The legislation, which was passed on partisan grounds, has had strong support from its proponents, while attracting ongoing criticism from its opponents.…”

Section: Impetus For Reformmentioning

confidence: 99%

A Critical Analysis of Obamacare: Affordable Care or Insurance for Many and Coverage for Few?

Manchikanti¹,

Helm²,

Benyamin³

et al. 2017

Pain Phys

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The Affordable Care Act (ACA), of 2010, or Obamacare, was the most monumental change in US health care policy since the passage of Medicaid and Medicare in 1965. Since its enactment, numerous claims have been made on both sides of the aisle regarding the ACA’s success or failure; these views often colored by political persuasion. The ACA had 3 primary goals: increasing the number of the insured, improving the quality of care, and reducing the costs of health care. One point often lost in the discussion is the distinction between affordability and access. Health insurance is a financial mechanism for paying for health care, while access refers to the process of actually obtaining that health care. The ACA has widened the gap between providing patients the mechanism of paying for healthcare and actually receiving it. The ACA is applauded for increasing the number of insured, quite appropriately as that has occurred for over 20 million people. Less frequently mentioned are the 6 million who have lost their insurance. Further, in terms of how health insurance is been provided, the majority the expansion was based on Medicaid expansion, with an increase of 13 million. Consequently, the ACA hasn’t worked well for the working and middle class who receive much less support, particularly those who earn more than 400% of the federal poverty level, who constitute 40% of the population and don’t receive any help. As a result, exchange enrollment has been a disappointment and the percentage of workers obtaining their health benefits from their employer has decreased steadily. Access to health care has been uneven, with those on Medicaid hampered by narrow networks, while those on the exchanges or getting employer benefits have faced high out-of-pocket costs. The second category relates to cost containment. President Obama claimed that the ACA provided significant cost containment, in that costs would have been even much higher if the ACA was not enacted. Further, he attributed cost reductions generally to the ACA, not taking into account factors such as the recession, increased out-of-pocket costs, increasing drug prices, and reduced coverage by insurers. The final goal was improvement in quality. The effort to improve quality has led to the creation of dozens of new agencies, boards, commissions, and other government entities. In turn, practice management and regulatory compliance costs have increased. Structurally, solo and independent practices, which lack the capability to manage these new regulatory demands, have declined. Hospital employment, with its associated increased costs, has been soaring. Despite a focus on preventive services in the management of chronic disease, only 3% of health care expenditures have been spent on preventive services while the costs of managing chronic disease continue to escalate. The ACA is the most consequential and comprehensive health care reform enacted since Medicare. The ACA has gained a net increase in the number of individuals with insurance, primarily through Medicaid expansion. The reduction in costs is an arguable achievement, while quality of care has seemingly not improved. Finally, access seems to have diminished.This review attempts to bring clarity to the discussion by reviewing the ACA’s impact on affordability, cost containment and quality of care. We will discuss these aspects of the ACA from the perspective of proponents, opponents, and a pragmatic point of view. Key words: Affordable Care Act (ACA), Obamacare, Medicare, Medicaid, Medicare Modernization Act (MMA), cost of health care, quality of health care, Merit-Based Incentive Payments System (MIPS)

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Section: Impetus For Reformmentioning

confidence: 99%

A Critical Analysis of Obamacare: Affordable Care or Insurance for Many and Coverage for Few?

Manchikanti¹,

Helm²,

Benyamin³

et al. 2017

Pain Phys

View full text Add to dashboard Cite

show abstract

“…The ACA had two fundamental but arguably disparate goals: (1) increasing the number of the insured; and (2) reducing the costs of healthcare. The ACA has clearly increased the number of people with insurance, with frequently quoted estimates in the range of 20 million additional people covered 26. This increase has been largely accomplished through two mechanisms: Medicaid expansion and, to a lesser extent, establishment of the health insurance marketplace (also referred to as health exchanges) 27.…”

Section: The Affordable Care Act (Aca): 2017 Statusmentioning

confidence: 99%

Contextualizing the first-round failure of the AHCA: down but not out

Hirsch

Rosenkrantz

Nicola

et al. 2017

J NeuroIntervent Surg

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On 8 November 2016 the American electorate voted Donald Trump into the Presidency and a majority of Republicans into both houses of Congress. Since many Republicans ran for elected office on the promise to ‘repeal and replace’ Obamacare, this election result came with an expectation that campaign rhetoric would result in legislative action on healthcare. The American Health Care Act (AHCA) represented the Republican effort to repeal and replace the Affordable Care Act (ACA). Key elements of the AHCA included modifications of Medicaid expansion, repeal of the individual mandate, replacement of ACA subsidies with tax credits, and a broadening of the opportunity to use healthcare savings accounts. Details of the bill and the political issues which ultimately impeded its passage are discussed here.

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“…Although more people have health insurance post-ACA, the level of individual coverage is still low. Many enrollees select bronze-level insurance plans, which essentially provide only catastrophic coverage 16. Adequate coverage is still unaffordable to many, and out-of-pocket costs have increased.…”

Section: Introduction To Health Care Reform In the Usamentioning

confidence: 99%

“…Adequate coverage is still unaffordable to many, and out-of-pocket costs have increased. Medicaid and Medicare Advantage coverage has expanded, and employer-sponsored plans have remained at the expense of state-sponsored exchange plans 3,16. Some insurance companies (eg, Dartmouth17 and UnitedHealthcare18) are dropping out of “ObamaCare” exchanges, as these are viewed as financially unattractive, and key stakeholders are withdrawing from the ACO market.…”

Section: Introduction To Health Care Reform In the Usamentioning

confidence: 99%

Can biosimilars help achieve the goals of US health care reform?

Boccia

Jacobs

Popovian

et al. 2017

CMAR

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The US Patient Protection and Affordable Care Act (ACA) aims to expand health care coverage, contain costs, and improve health care quality. Accessibility and affordability of innovative biopharmaceuticals are important to the success of the ACA. As it is substantially more difficult to manufacture them compared with small-molecule drugs, many of which have generic alternatives, biologics may increase drug costs. However, biologics offer demonstrated improvements in patient care that can reduce expensive interventions, thus lowering net health care costs. Biosimilars, which are highly similar to their reference biologics, cost less than the originators, potentially increasing access through reduced prescription drug costs while providing equivalent therapeutic results. This review evaluates 1) the progress made toward enacting health care reform since the passage of the ACA and 2) the role of biosimilars, including the potential impact of expanded biosimilar use on access, health care costs, patient management, and outcomes. Barriers to biosimilar adoption in the USA are noted, including low awareness and financial disincentives relating to reimbursement. The evaluated evidence suggests that the ACA has partly achieved some of its aims; however, the opportunity remains to transform health care to fully achieve reform. Although the future is uncertain, increased use of biosimilars in the US health care system could help achieve expanded access, control costs, and improve the quality of care.

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The Future of the Affordable Care Act

Cited by 21 publications

References 1 publication

A Critical Analysis of Obamacare: Affordable Care or Insurance for Many and Coverage for Few?

A Critical Analysis of Obamacare: Affordable Care or Insurance for Many and Coverage for Few?

Contextualizing the first-round failure of the AHCA: down but not out

Can biosimilars help achieve the goals of US health care reform?

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