The Affordable Care Act as a national experiment : health policy innovations and lessons

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 wa s 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. Preface Contents Contributors Chapter 1: Introduction: An Overview of the ACA as a National Experiment References Chapter 2: A Decade of ACA: The Successes, Unfinished Work, and Impact of the Affordable Care Act The ACA’s Successes Reforms to Healthcare Delivery Still Stand The Expansion of Medicaid in States Across the Country Despite the Negative Predictions from Opponents, the Market Embraces and Protects the ACA The ACA Is Promoting and Encouraging Innovation in Healthcare Delivery The Unfinished Work of the ACA Medicaid Expansion Needs to Exist in All States and Without Work Requirements Subsidies Should Be Adequate in Every State to Ensure That Everyone Has Access to Healthcare State Marketplaces Need More Health Plans at Affordable Prices A Public Option Is Now Being Reconsidered as a Part of the ACA The Legacy of the ACA References Chapter 3: Patient Protections in the Affordable Care Act A History of Patients’ Rights Efforts Overview of Patient Protections in the ACA Evaluating Whether the ACA’s Patient Protections Have Been Effective and What Areas Need Improvement A Path Toward More Comprehensive Protections References Chapter 4: Beyond Coverage and Controversy: The ACA’s Distinctly American Approach to Healthcare Coverage and Reform The ACA’s Legislative History The ACA Approach to Healthcare Reform Looking Forward: US Healthcare Coverage Compared to Other Developed Nations Can Policymakers Build on ACA’s Progress? References Chapter 5: Medicaid Expansion and Insurance Reform Under the Affordable Care Act: The New Federalism of Health Policy or the Same Old Same Old? A Brief History of Federalism in US Health Policy The ACA and Health Insurance Coverage The ACA and Health Insurance Regulation Federalism in US Health Policy Post-ACA References Chapter 6: Policies Designed to Achieve a Data-Driven Learning Healthcare System: A Decade of Progress and Future Directions The Triple Aim and the ACA: From Theory to Strategy Early Health IT Experiments: Beacon Communities Health IT Legislation After the ACA and Future Implications References Chapter 7: The Healthcare Message Wars Healthcare Messaging Pre-ACA White House Messaging Falters After Passage of the ACA Healthcare Prominent in 2016 Presidential Campaign Pelosi Moves to Reclaim Healthcare Messaging 2020 Presidential Candidates Search for Rhetorical Sweet Spot References Chapter 8: The Role of the Supreme Court in Shaping the Affordable Care Act National Federation of Independent Business (NFIB) v. Sebelius Other Challenges to the ACA References Chapter 9: The Center for Medicare and Medicaid Innovation – A Decade of Experimentation and Continued Evolution A Decade of Models and Results Accountable Care Organizations Advanced Primary Care Bundled Payments Health Promotion and System Transformation Second Decade of Innovation, Opportunities, and Challenges Emphasizing Accountability and Managing Total Cost of Care Improving How Models Are Designed and Tested Building the Evidence for Expansion and Dissemination Moving Private Payers into Value-Based Payment Models Continuing to Test and Evaluate Models References Chapter 10: Social Determinants: Working Upstream to Solve Health Problems Before They Start Social Determinants: A Primer Examples of Social Determinants of Health Economic Stability Education Social and Community Context Neighborhood and Built Environment Health and Healthcare The Difference Between Addressing Social Determinants of Health and Addressing Individual Social Needs Social Determinants Programs in the United States Health System Programs Addressing Health-Related Social Needs Boston Medical Center’s Housing Initiative MANNA’s Nutrition Program REACH’s Mammograms Public Programs Addressing Social Determinants of Health SNAP Public Housing Public Education Think Globally, Act Locally References Chapter 11: Stories of the Uninsured Coverage Gaps Coverage Churn Citizenship Status Work Requirements Being Uninsured Affects All Income Levels Being Underinsured Preexisiting Conditions Before the ACA Twenty-Eight Million Americans Are Uninsured References Chapter 12: Can Fifty-One Laboratories Cure What Ails the Individual Health Insurance Markets? Switching to a State-Based Marketplace Establishing a State Reinsurance Program Restricting the Sale of Individual Health Insurance That Is Non-compliant with the ACA Enacting State Individual Mandates Expanding Subsidies Implementing a Public Option Buy-In Program Conclusion References Chapter 13: What’s Next: The Push for Universal Healthcare Uncovered: The Remaining Uninsured—Who Are They? The Coverage Gap Citizenship Status Barely Covered: The Underinsured—A Growing Problem A Solution: Universal Healthcare Medicare for All A Public Option Expanding the ACA Getting There: The Funding Getting There: The Politics My Observations References Epilogue Index The landmark 2010 Patient Protection and Affordable Care Act (ACA), "Obamacare," was the largest healthcare policy innovation in the United States in 50 years, and it has generated strong opinions and debate across public, political, and policy arenas. Examining the innovation of the ACA as a health policy experiment, The Affordable Care Act as a National Experiment was published by Springer in 2014. Now, six years later, following an election year in which the ACA remained hotly debated, this second edition further examines the history, lessons, and impact of this ground-breaking legislation. Written by national healthcare policy leaders involved in the ACA's creation and implementation, this book addresses questions around patient protection under the ACA, delves into Medicaid expansion and insurance reform, assesses the Supreme Court review of the ACA, and sheds light on the related social determinants of health. It also provides informative stories of the uninsured. It discusses the stabilization of the ACA, and concludes with a summary of potential next steps and the push for universal healthcare. This second edition further underscores that to improve access to medical care and the public's health, we must innovate - and to innovate is to experiment. It makes clear that the ACA is a "translational medical research" experiment - an experiment aimed at translating best medical knowledge into improvements in health. And it shows that, like any medical experiment, its results will point to needed next steps. We hope this text becomes an essential resource for healthcare providers, policy makers, and academics.