Abstract
The Patient Protection and Affordable Care Act aims to increase access to care and improve the quality of care while simultaneously lowering the total cost of care. But have we delivered on these promises? With some political stakeholders looking to scale back or repeal specific reforms, certain low-income and disadvantaged groups may not have access to the affordable coverage options originally envisioned. Demonstrations at the ground level often yield surprising results that further threaten the original objectives. There has also been a delay in developing successful payment models and quality reporting systems across different patient populations and payers. As a result, developing an iterative evaluation process that informs policy makers at regular intervals will be essential in assuring that the Affordable Care Act achieves what it set out to do.
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References
Jennings CC. Implementation and the legacy of health care reform. N Engl J Med. 2010;362(15):351.
Holahan J, Buettgens M, Carroll C, Dorn S. The cost and coverage implications of the ACA medicaid expansion: national and state-by-state analysis. The Urban Institute; November 2012. Available from: http://www.kff.org/medicaid/upload/8384.pdf
Estimates for the Insurance Coverage Provisions of the Affordable Care Act Updated for the Recent Supreme Court Decision. Congressional Budget Office; July 2012. Available from: http://cbo.gov/sites/default/files/cbofiles/attachments/43472-07-24-2012-CoverageEstimates.pdf
Summary: five basic facts on immigrants and their health care. Kaiser Family Foundation; March 2008. Available from: http://www.kff.org/medicaid/upload/7761.pdf
McGuire TG, Sinaiko AD. Regulating a health insurance exchange: implications for individuals with mental illness. Psychiatr Serv. 2010;61(11):1074–80.
Singhal S, Stueland J, Ungerman D. How US health care reform will affect employee benefits. McKinsey Quarterly; June 2011.
Employer survey on US health care reform: details regarding the survey methodology. McKinsey; 20 June 2011. Available from: http://www.mckinsey.com/features/us_employer_healthcare_survey
Long SK, Stockley K. Massachusetts health reform: employer coverage from employees’ perspective. Health Aff. 2009;28(6):1079–87.
Essential Health Benefits Bulletin. Center for Consumer Information and Insurance Oversight; 16 December 2011. Available from: http://cciio.cms.gov/resources/files/Files2/12162011/essential_health_benefits_bulletin.pdf
Iglehart JK. Defining essential health benefits—the view from the IOM Committee. N Engl J Med. 2011;365(16):1461–3.
Obama administration moves forward to implement health care law, ban discrimination against people with pre-existing conditions. News Release. Department of Health and Human Services; 20 November 2012. Available from: http://www.hhs.gov/news/press/2012pres/11/20121120a.html
Levey NN. Passing the buck—or empowering states? who will define essential health benefits? Health Aff. 2012;31(4):663–6.
Dorn S. The basic health program option under federal health reform: issues for consumers and states. The Urban Institute; March 2011. Available from: http://www.urbaninstitute.org/UploadedPDF/412322-Basic-Health-Program-Option.pdf
Cassidy A. Basic Health Program. Health Policy Brief. Health Aff. 15 November 2012. Available from: http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=80
Bachrach D, Dutton M, Tolbert J, Harris J. The role of the basic health program in the coverage continuum: opportunities, risks and considerations. Kaiser Family Foundation and Manatt, Phelps, and Phillips, LLP; March 2012. Available from: http://www.kff.org/healthreform/upload/8283.pdf
Estimate of direct spending and revenue effects for the amendment in the nature of a substitute released on March 18, 2010. Congressional Budget Office; 18 March 2010. Available from: http://www.cbo.gov/publication/21351
Affordable care act update: implementing medicare cost savings. CMS Office of the Actuary. 2010. Available from: http://www.cms.gov/apps/docs/aca-update-implementing-medicare-costs-savings.pdf
Medicare acute care episode demonstration for orthopedic and cardiovascular surgery. Centers for Medicare and Medicaid Services. Available from: http://www.cms.gov/Medicare/DemonstrationProjects/DemoProjectsEvalRpts/downloads/ACE_web_page.pdf
Colla CH, et al. Spending differences associated with the Medicare Physician Group Practice Demonstration. J Am Med Assoc. 2012;308(10):1015–23.
Mangione-Smith T, et al. The quality of ambulatory care delivered to children in the United States. N Engl J Med. 2007;357:1515–23.
Children’s health care spending report: 2007–2010. Health Care Cost Institute; July 2012. Available from: http://www.healthcostinstitute.org/files/HCCI_CHCSR20072010.pdf
Guterman S, Davis K, Stremikis K, Drake H. Innovation in medicare and medicaid will be central to health reform’s success. Health Aff. 2010;29(6):1188–93.
Jost TS. The independent payment advisory board. N Engl J Med. 2010;363:103–5.
Estimated Financial Effects of the ‘Patient Protection and Affordable Care Act,’ as Amended. Centers for Medicare and Medicaid Services. Office of the Actuary; April 2010. Available from: http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/ActuarialStudies/downloads/PPACA_2010-04-22.pdf
Chernew ME, Rosen AB, Fendrick AM. Value based insurance design. Health Aff. 2007;26(2):195–203.
Choudhry NK, Rosenthal MB, Milstein A. Assessing the evidence for value-based insurance design. Health Aff. 2010;29(11):1988–94.
The University of Michigan Center for Value-Based Insurance Design. Available from: http://www.vbidcenter.org
McGlynn EA, Brook RH. Keeping quality on the policy agenda. Health Aff. 2001;20(3):82–90.
Centers for Medicare and Medicaid Services. Physician Quality Reporting System. Available from: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html
Hoo E, Lansky D, Roski J, Simpson L. Health plan quality improvement strategy reporting under the affordable care act: implementation considerations. The Commonwealth Fund; April 2012
2012 Annual report on the quality of care for children in medicaid and CHIP. Department of Health and Human Services; December 2012. Available from: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-of-Care/Downloads/2012-Ann-Sec-Rept.pdf
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Patel, K., West, M. (2014). Delivering on the Promise of the Affordable Care Act. In: Selker, H., Wasser, J. (eds) The Affordable Care Act as a National Experiment. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8351-9_3
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