Repeal and Replace of Affordable Care: A Complex, but Not an Impossible Task

The Affordable Care Act 10 Years In: What Nursing Leaders Should Know

Patient-Centered Outcomes Research: Early Evidence From A Burgeoning Field.

Arguments in Texas raise questions about the ACA's fate as enrollment holds steady and new state reinsurance waivers are approved.

Long-Term Care Reforms Live On With Court Ruling

For over four decades, Americans have enjoyed near universal access to treatment for ESRD irrespective of age, lack of qualifying disability, or their ability to pay. However, the health insurance benefits of the Medicare ESRD program do not extend to individuals in earlier stages of CKD, even to

The 2010 Patient Protection and Affordable Care Act (ACA) eliminated the restrictions on preexisting conditions for health care coverage. Little is known about the effects of the ACA on health care access among individuals with chronic health conditions. To determine how the implementations of the ACA affected health care access for adults with chronic health conditions. Data from respondents aged 18 to 64 years to the 2011-2017 nationally representative Behavioral Risk Factor Surveillance System (BFRSS) who reported preexisting chronic health conditions (n = 1 133 609). Multivariable logistic regression models were used to examine the changes in health care access from 2011-2013 (before the ACA) to 2015-2017 (after the ACA), overall and by sociodemographic groups. Self-reported access to health care coverage, skipped doctor visits because of cost issues, and having a routine checkup in the past 12 months. The percentage of adults with chronic health conditions having no health care coverage declined from 19.7% before the ACA to 11.9% after the ACA (adjusted odds ratio [AOR] = 0.5], P < .001), the percentage of skipped doctor visits because of cost declined from 24.6% to 20.0% (AOR = 0.8, P < .001), and the percentage with an annual routine checkup increased from 69.6% to 72.5% (AOR = 1.1, P < .001). The improvements in health care access were pronounced across sociodemographic groups after the ACA, especially among some disadvantaged groups (ie, young adults, non-Hispanic Blacks and Hispanics, and those with low income and low education). However, substantial disparities in health care access persisted, especially among individuals with low socioeconomic status. This study identifies substantial improvements in health care access among adults with chronic health conditions after ACA implementation, especially among disadvantaged populations.

Back to table of contents Previous article Next article Government NewsFull AccessStates Receive Guidance on Health-Reform WaiversRichard FaustRichard FaustSearch for more papers by this authorPublished Online:15 Apr 2011https://doi.org/10.1176/pn.46.8.psychnews_46_08_10_1AbstractIn March the departments of Health and Human Services (HHS) and Education issued a proposed rule for states applying for waivers from provisions of the Affordable Care Act (ACA). In addition, President Obama has announced his support for bipartisan legislation that would move the timeline for availability of state waivers from 2017 to 2014. In January's State of the Union Address, the president stressed that he was open to new ideas for improving the health care reform law. Echoing this commitment, HHS Secretary Kathleen Sebelius stated in a press release announcing the new rule that "Innovation Waivers empower states to take the lead on implementing the Affordable Care Act." The waivers are designed to give states the latitude to implement their own health care policies, which may differ from those in the ACA as long as they meet specified criteria. The press release lays out the criteria contained in the proposed rule, requiring states to provide coverage that meet these requirements: It must be at least as comprehensive as that offered through health insurance exchanges—new competitive, private health insurance marketplaces. It must be at least as affordable as the cost-sharing protect ions through the exchanges.It must provide coverage to at least as many residents as otherwise would have been covered under the Affordable Care Act.It must not increase the federal deficit.An HHS fact sheet on the proposed rule notes that states receiving waivers would also be required to submit quarterly and annual reports tracking measures in the four areas listed above and that the regulations suggest areas for continued monitoring of the waivers, such as choice of health plans and coverage of individuals with preexisting conditions. The president has thrown his support behind a bipartisan bill to move the start date for implementation of state waivers from 2017 to 2014. The start date is important because many of the provisions of the ACA do not go into effect until 2014. If states can receive wavers at that time, they can continue with any innovations they already have in the works without stopping to switch to implementing the federal requirements. Sens. Ron Wyden (D-Ore.) and Scott Brown (R-Mass.) first introduced the Empowering States to Innovate Act last November. In a press release Wyden stated that "some of the most innovative approaches to health policy have originated at the local level, where lawmakers have a unique insight into their constituents' lives, and the state waiver simply gives states the bandwidth to pursue those kinds of approaches." Brown said that "states shouldn't be forced by the federal government to adopt a one-size-fits-all health care plan." Julie Clements, deputy director for regulatory affairs in APA's Department of Government Relations, stated that "we support the secretary's requirement that any innovative state programs substituting for Affordable Care Act provisions must still satisfy the ACA's goals of coverage, cost-sharing, and comprehensive benefits. These requirements preclude the waiver program from being a means to circumvent the goals of ACA regarding coverage, cost-sharing, and comprehensiveness." APA will likely submit brief comments to the Centers for Medicare and Medicaid Services reiterating support for the goals of ACA and the hope that states that "do innovate will go above and beyond the more positive aspects of the ACA and how it treats mental health." The comment period on the proposed rule is open until May 13.The proposed rule is listed in theFederal Register at <http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=2011_register&docid=fr14mr11-23.pdf>. The Empowering States to Innovate Act is posted at <http://thomas.loc.gov/cgi-bin/query/z?c112:H.R.844:>. ISSUES NewArchived

What now?

APhA highlights CMS’s recognition of MTM

The American Catholic Church has a long history in health care. At the turn of 19th century, Catholic nuns began developing the United States’ first hospital and health care systems, amassing a high level of professionalization and expertise in the field. The bishops also have a well-established record advocating for healthcare, stemming back to 1919 with the Bishops’ Program for Social Reconstruction, which called for affordable and comprehensive care, particularly for the poor and vulnerable. Moving into the latter part of the 20th century, the bishops continued to push for health care reform. However, in the aftermath of Roe v. Wade (1973), the American bishops insisted that any reform or form of universal health care be consistent with the Church’s teaching against abortion, contraception, and euthanasia. The bishops were also adamant that health care policy respect religious liberty and freedom of conscience. In 1993, these concerns caused the bishops to pull their support for the Clinton Administration’s Health Security Act, since the bill covered abortion as a medical and pregnancy-related service. The debate over health care in the 1990s served as a precursor for the United States Conference of Catholic Bishops’ (USCCB) opposition to the Obama Administration’s Affordable Care Act (ACA) and the Department of Health and Human Services’ (HHS) contraception mandate. The ACA also highlighted a divide within the Church on health care among religious leaders. For example, progressive female religious leadership organizations, such as the Leadership Conference of Women Religious (LCWR) and their affiliate NETWORK (a Catholic social justice lobby), took a different position than the bishops and supported the ACA, believing it had enough protections against federally funded abortion. Though some argue this divide lead to institutional scrutiny of the sisters affiliated with the LCWR and NETWORK, both the bishops and the nuns have held common ground on lobbying the government for affordable, comprehensive, and universal health care.

This chapter examines the Obama presidency, the politics of race and health care, and the role that African Americans played in shaping the Affordable Care Act (ACA). We argue that race—and specifically the elimination of racial and health disparities—was very much part of the ACA’s development. From the perspective of Black lawmakers health equity and patient protection advocates, who worked hand-in-glove with the Obama administration, the ACA was not race-neutral or indifferent to Blacks and the working poor. The law had special significance for African Americans despite Obama publicly discussing its impact in deracialized terms. Daniel Dawes, a leading advocate for health equity and author of the groundbreaking book 150 Years of Obamacare, called the ACA the “most comprehensive minority health law” and the “most inclusive [health] law” in the history of the United States. He identified sixty-two provisions that “directly address inequities in health care” that are embedded in the ACA.” This chapter thus argues that Obama’s ACA was substantively accountable to the coalition of Black lawmakers and activists—what we refer to as a policy ecosystem—who were purposeful about incorporating provisions in the bill designed to reduce racial disparities and income-based inequities in health care.

Holding on to a huge victory for American health

The idea of a public health insurance option is at least a half century old, but has not yet had its day in the limelight. This chapter explains why if that moment ever comes, health care’s public option will fall short of expectations that it will provide a differentiated, meaningful alternative to private health insurance and will spur health insurance competition. Health care’s public option bubbled up in its best-known form in California in the early 2000s and got increasing mainstream attention in the lead up to the 2010 health reform, the Patient Protection and Affordable Care Act (ACA). The idea has reemerged with vigor once again as a core tenet of Democratic presidential nominee Joe Biden’s plans to build on the ACA. When people talk about health care’s public option, they mean a public health insurance plan, typically based on Medicare that someone could select in the individual, or nongroup, health insurance market instead of a private health insurance offering. Proponents have argued that a public health insurance option could deliver better cost-control than private insurance, while also being able to offer a broad choice of providers and quality control. Health care’s public option died in the 2010 ACA legislative process, but had it been enacted, it would have faced serious obstacles to produce these results its architects hoped. The assumption that people will select the public option if it is better than other options is belied by a mounting body of empirical literature showing how we struggle, and do not do all that well, when choosing among health insurance options. Even more, political thorniness would almost certainly have prevented the public option from being a clear best alternative, which would have further impeded its ability to stand out in a crowd of options. If consumers fail to gravitate overwhelmingly to a public option, it cannot catalyze the market pressure necessary to produce lower prices or higher quality. For a public health insurance option to have transformative potential—to promote greater health equity and freedom—it needs to be more than an option among many, what Sitaraman and Alstott call a competitive public option. It must be designed in a way that does not rely on people weighing it against other options and selecting it when it is the best. This chapter examines possibilities for health care’s public option in three parts. It first explains the theory behind health care’s competitive public option, the form envisioned in the ACA and similar to early proposals by the Biden Campaign during the Democratic primaries. It then considers the challenges this competitive public option would have faced had it become policy reality. Finally, it examines more effective ways that public health insurance might be integrated into a public/private hybrid system to achieve greater health equity.

On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law. This comprehensive health care reform legislation sought to expand health care coverage to millions of Americans, control health care costs, and improve the overall quality of the health care system. The ACA required that all US citizens and legal residents have qualifying health insurance by 2014. In this paper we give readers a brief overview of the effects of the ACA based on recent research. We then turn our attention to the possibility of using the ACA expansion to answer important underlying questions, such as: To what extent does the holding of insurance lead to improvements in access to care? To what extent does the holding of coverage lead to improvements in health? In mental health? Are there likely general equilibrium effects on labor force participation, hours worked, employment setting, and indeed even the probability of marrying? By necessity, researchers' ability to answer these questions depends on the availability of data, so we discuss current and potential data sources relevant for answering these questions. We also look to what has been studied about the health reform in Massachusetts and early Medicaid expansions to speculate what we can expect to learn about the effects of the ACA on these outcomes in the future.

One of the most significant health care reforms since the implementation of Medicare and Medicaid, the Affordable Care Act (ACA) enacted into law in 2010, was met with widespread criticism. The expansion of Medicaid eligibility was a specific focus of these critiques as sceptics believed the long-term effects would be primarily negative for both the physical and fiscal health of the population. This article provides a brief history of the ACA along with the role of political and public opinion. This is followed with an analysis of initial criticisms and concerns surrounding the eligibility and expansion—with a brief discussion of the constitutionality of the law. Finally, while the long-term effects of the ACA upon health care access and service in the USA are yet to be seen, preliminary results indicate positive effects, contrary to the negatives originally assumed. The article concludes with a summary of current health care reform and a prospective on the future of health care reform in the USA.