JOURNAL ARTICLE
REVIEW

United States Health Care Reform: Progress to Date and Next Steps

Barack Obama
JAMA: the Journal of the American Medical Association 2016 August 2, 316 (5): 525-32
27400401

IMPORTANCE: The Affordable Care Act is the most important health care legislation enacted in the United States since the creation of Medicare and Medicaid in 1965. The law implemented comprehensive reforms designed to improve the accessibility, affordability, and quality of health care.

OBJECTIVES: To review the factors influencing the decision to pursue health reform, summarize evidence on the effects of the law to date, recommend actions that could improve the health care system, and identify general lessons for public policy from the Affordable Care Act.

EVIDENCE: Analysis of publicly available data, data obtained from government agencies, and published research findings. The period examined extends from 1963 to early 2016.

FINDINGS: The Affordable Care Act has made significant progress toward solving long-standing challenges facing the US health care system related to access, affordability, and quality of care. Since the Affordable Care Act became law, the uninsured rate has declined by 43%, from 16.0% in 2010 to 9.1% in 2015, primarily because of the law's reforms. Research has documented accompanying improvements in access to care (for example, an estimated reduction in the share of nonelderly adults unable to afford care of 5.5 percentage points), financial security (for example, an estimated reduction in debts sent to collection of $600-$1000 per person gaining Medicaid coverage), and health (for example, an estimated reduction in the share of nonelderly adults reporting fair or poor health of 3.4 percentage points). The law has also begun the process of transforming health care payment systems, with an estimated 30% of traditional Medicare payments now flowing through alternative payment models like bundled payments or accountable care organizations. These and related reforms have contributed to a sustained period of slow growth in per-enrollee health care spending and improvements in health care quality. Despite this progress, major opportunities to improve the health care system remain.

CONCLUSIONS AND RELEVANCE: Policy makers should build on progress made by the Affordable Care Act by continuing to implement the Health Insurance Marketplaces and delivery system reform, increasing federal financial assistance for Marketplace enrollees, introducing a public plan option in areas lacking individual market competition, and taking actions to reduce prescription drug costs. Although partisanship and special interest opposition remain, experience with the Affordable Care Act demonstrates that positive change is achievable on some of the nation's most complex challenges.

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Le Zhang

Residents of Pinal County, AZ should give this article a read

1

Greg Hauck

This article is partisan and omits other "facts". How about speaking about the overall significant increase regarding insurance premiums and the continued increase in the cost of medical care. The "affordable health care act" has done nothing to make health care affordable and only continued to push for a single payer system.

1

Alexander Tummers

It's articles like this that prove the AMA to be nothing more than a mouthpiece for liberal policy, and why I refuse to join. Utter dreck.

0

Olivier Lozinguez

Des

0

homan wai

Wrong article

0

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