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RED HOT Contributors


United States Health Care Reform: Progress to date and next steps


The Affordable Care Act has made significant progress toward solving long-standing challenges facing the U.S. health care system related to access, affordability, and quality of care, although major opportunities to improve the health care system remain, according to an article published online by JAMA from President Barack Obama, Executive Office of the President, Washington, D.C.

The Affordable Care Act (ACA) is the most important health care legislation enacted in the United States since the creation of Medicare and Medicaid in 1965. This article examines the factors influencing the decision to pursue health reform and the evidence on the effects of the law to date, provides recommendations on actions that could improve the health care system, and identifies general lessons for public policy from the ACA. The article involved an analysis of publicly available data (from 1963 to early 2016), data obtained from government agencies and published research findings.

Progress Under the ACA

The ACA has succeeded in sharply increasing insurance coverage. Since the ACA became law, the uninsured rate has declined by 43 percent, from 16 percent in 2010 to 9.1 percent in 2015, with most of that decline occurring after the law’s main coverage provisions took effect in 2014. The number of uninsured individuals in the United States has declined from 49 million in 2010 to 29 million in 2015.

Early evidence indicates that expanded coverage is improving access to treatment, financial security, and health for the newly insured. Following the expansion through early 2015, nonelderly adults experienced substantial improvements in the share of individuals who have a personal physician (increase of 3.5 percentage points) and easy access to medicine (increase of 2.4 percentage points) and substantial decreases in the share who are unable to afford care (decrease of 5.5 percentage points) and reporting fair or poor health (decrease of 3.4 percentage points) relative to the pre-ACA trend. Research has also found that Medicaid expansion has improved the financial security of the newly insured (for example, by reducing the amount of debt sent to a collection agency by an estimated $600 – $1,000 per person gaining Medicaid coverage).

The law has also begun the process of transforming health care payment systems, with an estimated 30 percent 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. From 2010 through 2014, average annual growth in real per-enrollee Medicare spending has actually been negative. Similarly, average real per-enrollee growth in private insurance spending has been 1.1 percent per year since 2010, compared with an average of 6.5 percent from 2000 through 2005 and 3.4 percent from 2005 to 2010. The rate of hospital-acquired conditions (such as adverse drug events, infections, and pressure ulcers) has declined, as has the rate at which Medicare patients are readmitted to the hospital within 30 days after discharge

According to the article, despite the progress that has been made toward a more affordable, high-quality, and accessible health care system, too many Americans still strain to pay for their physician visits and prescriptions, cover their deductibles, or pay their monthly insurance bills; struggle to navigate a complex, sometimes bewildering system; and remain uninsured. More work to reform the health care system is necessary, and suggestions are offered in the article.


“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.”

Article: United States Health Care Reform Progress to Date and Next Steps, Barack Obama, JD, JAMA, doi:10.1001/jama.2016.9797, published online 11 July 2016.

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