The Affordable Care Act As A National Experiment

The landmark 2010 Patient Protection and Affordable Care Act (ACA), or “Obamacare,” is a topic of great debate in mainstream, academic, and scientific media that generated strong opinions across the political spectrum and our nation. Soon after the enactment of the ACA and the fierce debate that ensued, The Affordable Care Act as a National Experiment was published by Springer in 2014. Now five years later, just finishing an election year in which the ACA was a hotly debated issue, the second edition of this title examines the history, lessons, and impact of this ground-breaking legislation. Now a decade since implementation nationally, the ACA is the largest healthcare policy innovation in the United States in at least 50 years and one of our nation’s largest healthcare experiments ever. The history of public health and medicine shows us that to develop better solutions for important health problems, we must innovate. And when we try a new strategy, we are reminded that to innovate is to experiment. This is the basis of all medical research, public health interventions, and health policy innovations. Moreover, in recent years, there is an increasing emphasis on “translational science,” research that always has an ultimate focus on having real impact on medical care and the public’s health – whether in translating from bench research to the bedside, or from limited clinical use into widespread practice, public health interventions or policy. As with the previous edition, the book opens with a chapter that gives a basic overview of The Affordable Care Act. The second chapter, which previously discussed the objectives of the ACA, now takes a look at the successes, unfinished work and impact of the ACA in the past ten years. The third chapter now ponders the question of whether the ACA has protected patients since its implementation while its previous counterpart gave predictions for the future. The chapters that follow highlight things such as Medicaid expansion and insurance reform under the ACA, the Supreme Court Review of the ACA, social determinants of health, stories of the uninsured and stabilization of the ACA, among others. The book rounds out with a summary of what’s next and the push for universal healthcare followed by an epilogue. Due to the timely nature of the subject matter, some chapters from the previous edition have been dropped and seven new chapters have been added in their place. The remaining seven chapters from the previous edition have also been fully revised and updated. Written by nationally known healthcare policy leaders who were involved directly in the creation and implementation of the ACA, the second edition of The Affordable Care Act as a National Experiment again will examine the history and impact of this ground-breaking legislation as well as recommend priorities, objectives, and next steps for translational research. It is an essential resource for all healthcare providers as well as policy makers and academics.

Population Health Implications of the Affordable Care Act is the summary of a workshop convened in June 2013 by the Institute of Medicine Roundtable on Population Health Improvement to explore the likely impact on population health improvement of various provisions within the Affordable Care Act (ACA). This public workshop featured presentations and discussion of the impact of various provisions in the ACA on population health improvement. Several provisions of the ACA offer an unprecedented opportunity to shift the focus of health experts, policy makers, and the public beyond health care delivery to the broader array of factors that play a role in shaping health outcomes. The shift includes a growing recognition that the health care delivery system is responsible for only a modest proportion of what makes and keeps Americans healthy and that health care providers and organizations could accept and embrace a richer role in communities, working in partnership with public health agencies, community-based organizations, schools, businesses, and many others to identify and solve the thorny problems that contribute to poor health. Population Health Implications of the Affordable Care Act looks beyond narrow interpretations of population as the group of patients covered by a health plan to consider a more expansive understanding of population, one focused on the distribution of health outcomes across all individuals living within a certain set of geopolitical boundaries. In establishing the National Prevention, Health Promotion, and Public Health Council, creating a fund for prevention and public health, and requiring nonprofit hospitals to transform their concept of community benefit, the ACA has expanded the arena for interventions to improve health beyond the "doctor's" office. Improving the health of the population - whether in a community or in the nation as a whole - requires acting to transform the places where people live, work, study, and play. This report examines the population health-oriented efforts of and interactions among public health agencies (state and local), communities, and health care delivery organizations that are beginning to facilitate such action.

The Patient Protection and Affordable Care Act (ACA) was designed to increase health insurance quality and affordability, lower the uninsured rate by expanding insurance coverage, and reduce the costs of healthcare overall. Along with sweeping change came sweeping criticisms and issues. This book explores the pros and cons of the Affordable Care Act, and explains who benefits from the ACA. Readers will learn how the economy is affected by the ACA, and the impact of the ACA rollout.

The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.

While analyzing the contentious debate over health care reform, this much-needed study also challenges the argument that treating medical patients like shoppers can significantly reduce health expenditures. This revealing work focuses on the politics surrounding the Affordable Care Act (ACA), explaining how and why supporters and opponents have approached the issue as they have since the act's passage in 2010. The first book to systematically examine public knowledge of the ACA across time, it also documents how that knowledge has remained essentially static since 2010, despite the importance of health-policy reform to every American. An important book for anyone concerned about the skyrocketing costs of health care in the United States, the work accomplishes three main tasks intended to help readers better understand one of the most important policy challenges of our time. The early chapters explain why congressional Democrats designed the Affordable Care Act of 2010 as they did, clarifies some of the consequences of the act's features, and examines why Republicans have fought the implementation of the law so fiercely. The study then looks at how the intersection of economics and politics applies to the ACA. Finally, the book details what the public knows-and doesn't know-about the law and discusses the prospects for citizens gaining the knowledge they should have about the overall issue of health-policy reform.

Many of the elements of the Affordable Care Act (ACA) went into effect in 2014, and with the establishment of many new rules and regulations, there will continue to be significant changes to the United States health care system. It is not clear what impact these changes will have on medical and public health preparedness programs around the country. Although there has been tremendous progress since 2005 and Hurricane Katrina, there is still a long way to go to ensure the health security of the Country. There is a commonly held notion that preparedness is separate and distinct from everyday operations, and that it only affects emergency departments. But time and time again, catastrophic events challenge the entire health care system, from acute care and emergency medical services down to the public health and community clinic level, and the lack of preparedness of one part of the system places preventable stress on other components. The implementation of the ACA provides the opportunity to consider how to incorporate preparedness into all aspects of the health care system. The Impacts of the Affordable Care Act on Preparedness Resources and Programs is the summary of a workshop convened by the Institute of Medicine's Forum on Medical and Public Health Preparedness for Catastrophic Events in November 2013 to discuss how changes to the health system as a result of the ACA might impact medical and public health preparedness programs across the nation. This report discusses challenges and benefits of the Affordable Care Act to disaster preparedness and response efforts around the country and considers how changes to payment and reimbursement models will present opportunities and challenges to strengthen disaster preparedness and response capacities.

The Patient Protection and Affordable Care Act (ACA) was designed to increase health insurance quality and affordability, lower the uninsured rate by expanding insurance coverage, and reduce the costs of healthcare overall. Along with sweeping change came sweeping criticisms and issues. This book explores the pros and cons of the Affordable Care Act, and explains who benefits from the ACA. Readers will learn how the economy is affected by the ACA, and the impact of the ACA rollout.

The definitive story of American health care today -- its causes, consequences, and confusions. In March 2010, the Affordable Care Act was signed into law. It was the most extensive reform of America's health care system since at least the creation of Medicare in 1965, and maybe ever. The ACA was controversial and highly political, and the law faced legal challenges reaching all the way to the Supreme Court; it even precipitated a government shutdown. It was a signature piece of legislation for President Obama's first term, and also a ball and chain for his second. Ezekiel J. Emanuel, a professor of medical ethics and health policy at the University of Pennsylvania who also served as a special adviser to the White House on health care reform, has written a brilliant diagnostic explanation of why health care in America has become such a divisive social issue, how money and medicine have their own -- quite distinct -- American story, and why reform has bedeviled presidents of the left and right for more than one hundred years. Emanuel also explains exactly how the ACA reforms are reshaping the health care system now. He forecasts the future, identifying six mega trends in health that will determine the market for health care to 2020 and beyond. His predictions are bold, provocative, and uniquely well-informed. Health care -- one of America's largest employment sectors, with an economy the size of the GDP of France -- has never had a more comprehensive or authoritative interpreter.