Health Care Reform
On March 23, 2010 the Patient Protection and Affordable Care Act (ACA) was enacted. This federal law constitutes comprehensive reform of the American health care system, and will have transformative effects on public and private health insurance coverage, operation of health care markets, affordability and accessibility of insurance, and financing of medical care.
Major components of the reform include:
Enactment of the ACA brings extraordinary opportunities for greater security, affordability, adequacy, and equity in health insurance coverage. However, it also faces very substantial hurdles in both political and practical realms. These include the challenges of implementing substantial changes to the Medicaid program, significant reforms of private health insurance market regulations, development of new systems for delivering subsidies and enrolling individuals in coverage, creating greater transparency, and promoting efficiency in the delivery of health care. There is also the threat of repeal if there is a significant change in political leadership, and, at a minimum, there is likely to be opposition to implementation in several states. The Urban Institute’s Health Policy Center is committed to providing objective analyses of the issues inherent in these reforms.
States will play a vital role in the implementation of these reforms as well as in the design of specific aspects of the changes; consequently, variation across the country is likely to be considerable and coordination with the federal government complex. Redistribution of financing across states, the federal government, employers, and households means that all Americans and all stakeholders in the health care system will be touched by these changes in some respect.
The Urban Institute’s Health Policy Center recently started a multi-year project for the Robert Wood Johnson Foundation that will analyze the effects of the ACA on governments, employers, and households. This project will provide a comprehensive quantitative and qualitative assessment of reform-related changes. Major areas of interest include: coverage, access, utilization, affordability, spending, employer and individual premiums, financing, insurance exchanges, insurance reforms, Medicaid and subsidies, and provider issues. This work will cover a wide array of implementation issues at the national level, but the project’s central emphasis will be on analyses in ten focal states (Alabama, Colorado, Michigan, Maryland, Minnesota, New Mexico, New York, Oregon, Rhode Island, and California), allowing the research team to highlight the implications of states’ design choices and implementation strategies. The first two years of the project will be the early stage during which health reform implementation in each state begins. Although the biggest changes will not occur until 2014, what happens before then will be critical in determining the effectiveness of the full implementation. The project is designed to continue past 2014, allowing sufficient time to assess the fully implemented reforms.
The Urban Institute’s Health Policy Center staff also provides extensive technical assistance and analytic support to policymakers and others as the options for reform implementation are considered. Examples of recent work include: