1932

Abstract

Regardless of what legislation the federal government adopts to address health insurance coverage for nonelderly Americans, private insurance will likely play a major role. This article begins by listing some of the major reasons critics dislike the Affordable Care Act (ACA), then discusses the validity of these concerns from an economics perspective. Criticisms of the ACA include the increased role of government in health care, the ACA's implicit income redistribution, and concern about high and rising insurance premiums. Suggestions for refining the ACA and its market-based insurance system are then offered, with the goals of lowering insurance premiums, improving coverage rates, and/or addressing the concerns of ACA critics. Americans favor the increase in insurance coverage that has occurred under the ACA. In order to sustain this level of coverage, steps to lower Marketplace premiums through a variety of strategies affecting potential enrollees, insurers, and healthcare providers are offered.

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/content/journals/10.1146/annurev-med-052616-044854
2018-01-29
2024-06-16
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Literature Cited

  1. 1. Centers for Medicare and Medicaid Services. 2017. Health insurance marketplaces 2017 open enrollment period final enrollment report: November 1, 2016–January 1, 2017 CMS.gov https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-03-15.html [Google Scholar]
  2. 2. Office of the Assistant Secretary for Planning and Evaluation. 2017. U.S. federal poverty guidelines used to determine financial eligibility for certain federal programs. Poverty Guidelines. https://aspe.hhs.gov/poverty-guidelines [Google Scholar]
  3. 3. The Henry J. Kaiser Family Foundation. 2016. Medicaid expansion enrollment. Timeframe: FY 2016. Coverage under the Medicaid Expansion. http://kff.org/health-reform/state-indicator/medicaid-expansion-enrollment/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D [Google Scholar]
  4. Pindyck RS, Rubinfeld DL. 4.  1997. The analysis of competitive markets. Microeconomics289–329 Upper Saddle River, NJ: Prentice-Hall, 4th ed.. [Google Scholar]
  5. Arrow KJ. 5.  1963. Uncertainty and the welfare economics of medical care. Am. Econ. Rev. 53:5941–73 [Google Scholar]
  6. Akerlof GA. 6.  1970. The market for “lemons”: quality uncertainty and the market mechanism. Q. J. Econ. 84:3488 [Google Scholar]
  7. Sommers BD, Kenney GM, Epstein AM. 7.  2014. New evidence on the Affordable Care Act: coverage impacts of early Medicaid expansions. Health Aff. (Millwood) 33:178–87 [Google Scholar]
  8. Mulligan CB. 8.  2015. Side Effects and Complications: The Economic Consequences of Health-Care Reform Chicago: Univ. Chicago Press [Google Scholar]
  9. Gruber J. 9.  2005. Why study public finance?. Public Finance and Public Policy1–22 New York: Worth Publ. [Google Scholar]
  10. Phadke VK, Bednarczyk RA, Salmon DA. 10.  et al. 2016. Association between vaccine refusal and vaccine-preventable diseases in the United States. JAMA 315:111149–58 [Google Scholar]
  11. Hadley J, Holahan J. 11.  2003. How much medical care do the uninsured use, and who pays for it?. Health Aff 2003:Suppl.W3-66-81 [Google Scholar]
  12. Bundorf MK, Pauly MV. 12.  2006. Is health insurance affordable for the uninsured?. J. Health Econ. 25:4650–73 [Google Scholar]
  13. Alesina A, Angeletos G-M. 13.  2004. Fairness and redistribution. Am. Econ. Rev. 95:4960–80 [Google Scholar]
  14. 14. Pew Research Center. 2014. Most see inequality growing, but partisans differ over solutions U.S. Politics and Policy. Rep., Pew Res. Cent., Washington, DC http://www.people-press.org/2014/01/23/most-see-inequality-growing-but-partisans-differ-over-solutions/ [Google Scholar]
  15. Barnett JC, Vornovitsky M. 15.  2016. Health insurance coverage in the United States, 2015 United States Census Bureau https://www.census.gov/library/publications/2016/demo/p60-257.html [Google Scholar]
  16. 16. The Henry J. Kaiser Family Foundation, Health Research & Educational Trust. 2016. 2016 employer health benefits survey Health Costs. Rep., Henry J. Kaiser Family Found., Menlo Park, CA. http://kff.org/health-costs/report/2016-employer-health-benefits-survey/ [Google Scholar]
  17. Adler L, Ginsburg PB. 17.  2016. Obamacare premiums are lower than you think. Health Affairs Blog http://healthaffairs.org/blog/2016/07/21/obamacare-premiums-are-lower-than-you-think/ [Google Scholar]
  18. Cox C, Long M, Semanskee A. 18.  et al. 2016. 2017 Premium changes and insurer participation in the Affordable Care Act's health insurance marketplaces Henry J. Kaiser Family Foundation http://kff.org/health-reform/issue-brief/2017-premium-changes-and-insurer-participation-in-the-affordable-care-acts-health-insurance-marketplaces/ [Google Scholar]
  19. Brandeisky K. 19.  2016. 7 Dos and don'ts for freelancers buying health insurance. Money Jun. 13. http://time.com/money/4251595/best-healthcare-for-freelancers/ [Google Scholar]
  20. Fox JB, Shaw FE. 20.  2015. Clinical preventive services coverage and the Affordable Care Act. Am. J. Public Health 105:1e7–10 [Google Scholar]
  21. 21. Centers for Medicare and Medicaid Services, Center for Consumer Information and Insurance Oversight. 2016. HHS-Operated Risk Adjustment Methodology Meet., Mar. 31. Washington, DC:
  22. Cox C, Semanskee A, Claxton G, Levitt L. 22.  2016. Explaining health care reform: risk adjustment, reinsurance, and risk corridors Issue Brief, Henry J. Kaiser Family Foundation http://kff.org/health-reform/issue-brief/explaining-health-care-reform-risk-adjustment-reinsurance-and-risk-corridors/ [Google Scholar]
  23. Geruso M, McGuire TG. 23.  2016. Tradeoffs in the design of health plan payment systems: fit, power and balance. J. Health Econ. 47:1–19 [Google Scholar]
  24. 24. Centers for Medicare and Medicaid Services. 2015. Shared savings and losses and assignment methodology specifications Ver. 4. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/Shared-Savings-Losses-Assignment-Spec-V4.pdf [Google Scholar]
  25. Song Z, Rose S, Safran DG. 25.  et al. 2014. Changes in health care spending and quality 4 years into global payment. N. Engl. J. Med. 371:181704–14 [Google Scholar]
  26. Ho V, Allen TK, Kim U. 26.  et al. 2016. Measuring the cost implications of the Collaborative Accountable Care initiative in Texas. Am. J. Manag. Care 22:9304–10 [Google Scholar]
  27. Truffer CJ, Wolfe CJ, Rennie KE. 27.  2016. 2016 Actuarial report on the financial outlook for Medicaid Report to Congress. Cent. Medicare Medicaid Serv., US Dep. Health Hum. Serv. https://www.medicaid.gov/medicaid/financing-and-reimbursement/downloads/medicaid-actuarial-report-2016.pdf [Google Scholar]
  28. Jost T. 28.  2016. In annual baseline budget projections, CBO decreases marketplace enrollment estimates (update). Health Affairs Blog http://healthaffairs.org/blog/2016/03/25/in-annual-baseline-budget-projections-cbo-decreases-marketplace-enrollment-estimates/ [Google Scholar]
  29. Berwick DM, Hackbarth AD. 29.  2012. Eliminating waste in US health care. JAMA 307:141513–16 [Google Scholar]
  30. Schwartz AL, Landon BE, Elshaug AG. 30.  et al. 2014. Measuring low-value care in Medicare. JAMA Intern. Med. 2115:1–9 [Google Scholar]
  31. Neumann PJ, Rosen AB, Weinstein MC. 31.  2005. Medicare and cost-effectiveness analysis. N. Engl. J. Med. 353:141516–22 [Google Scholar]
  32. Gold MR, Sofaer S, Siegelberg T. 32.  2007. Medicare and cost-effectiveness analysis: time to ask the taxpayers. Health Aff 26:51399–406 [Google Scholar]
  33. Neumann PJ, Weinstein MC. 33.  2010. Legislating against use of cost-effectiveness information. N. Engl. J. Med. 363:161495–97 [Google Scholar]
  34. Avorn J. 34.  2009. Debate about funding comparative-effectiveness research. N. Engl. J. Med. 360:191927–29 [Google Scholar]
  35. Iglehart JK. 35.  2010. The political fight over comparative effectiveness research. Health Aff 29:101757–60 [Google Scholar]
  36. 36. ObamaCare Facts. 2017. ObamaCare employer mandate https://obamacarefacts.com/obamacare-employer-mandate/ [Google Scholar]
  37. Nather D. 37.  2013. How Obamacare affects businesses. Politico, Sep. 30. http://www.politico.com/story/2013/09/how-obamacare-affects-businesses-large-and-small-097460 [Google Scholar]
  38. Watts T. 38.  2014. ACA top concern: handling the administrative burden Mercer Signal, US Health News http://ushealthnews.mercer.com/article/169/aca-top-concern-handling-the-administrative-burden [Google Scholar]
  39. Sinaiko AD, Rosenthal MB. 39.  2016. Examining a health care price transparency tool: Who uses it, and how they shop for care. Health Aff 35:4662–70 [Google Scholar]
  40. Wu SJ, Sylwestrzak G, Shah C. 40.  et al. 2014. Price transparency for MRIs increased use of less costly providers and triggered provider competition. Health Aff 33:81391–98 [Google Scholar]
  41. Leiber EMJ. 41.  2017. Does it pay to know prices in health care?. Am. Econ. J. Econ. Policy 9:1154–79 [Google Scholar]
  42. 42. Centers for Medicare and Medicaid Services. National health expenditure data CMS.gov https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nationalhealthaccountshistorical.html [Google Scholar]
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