Expanding Choice through Defined Contributions: Overcoming a Non-Participatory Health Care Economy

2012 ◽  
Vol 40 (3) ◽  
pp. 558-573 ◽  
Author(s):  
Robert E. Moffit
Keyword(s):  
Affordable Care Act ◽  
House Of Representatives ◽  
The United States ◽  
Ballot Initiatives ◽  
Individual Mandate ◽  
The Affordable Care Act ◽  
Care Economy ◽  
Defined Contributions ◽  
Uncertain Future ◽  
The Individual

The Patient Protection and Affordable Care Act of 2010 (the Affordable Care Act) is the law of the land. But it faces an uncertain future.During congressional deliberations on the 2,700-page legislation leading up to its enactment, from February to March 2010, not one major survey recorded majority support for the legislation. Since its enactment, popular opposition to the Affordable Care Act has hardened, and was a significant factor in the 2010 congressional election, in which Democrats lost 63 seats and Republicans regained the majority in the House of Representatives. Ballot initiatives in Missouri and Ohio, showcasing popular opposition to the individual mandate, passed in 2010 with overwhelming majorities. While the United States Supreme Court in National Federation of Independent Business et al. v. Sebelius, 132 S. Ct. 2566 ( 2012), declared the mandate on the states to expand Medicaid unconstitutionally coercive, the majority of the Justices also upheld the individual mandate as a permissible tax. The new law thus emerged as a central topic in the 2012 election.

scholarly journals Sources of Success in California's Individual Marketplace under the Affordable Care Act

2019 ◽  
Vol 44 (4) ◽  
pp. 679-706
Author(s):  
Petra W. Rasmussen ◽  
Gerald F. Kominski
Keyword(s):  
Affordable Care Act ◽  
The United States ◽  
Community Partners ◽  
Early Adoption ◽  
Individual Market ◽  
The Affordable Care Act ◽  
The Law ◽  
The Stability ◽  
The Individual ◽  
Trump Administration

Abstract When passed in 2010, the Affordable Care Act (ACA) became the greatest piece of health care reform in the United States since the creation of Medicare and Medicaid. In the 9 years since its passage, the law has ushered in a drastic decrease in the number of uninsured Americans and has encouraged delivery system innovation. However, the ACA has not been uniformly embraced, and states differ in their implementation of the law and in their individual health insurance marketplace's successfulness. Furthermore, under the Trump administration the law's future and the stability of the individual market have been uncertain. Throughout, however, California has been a leader. Today, the state's marketplace, known as Covered California, offers comprehensive, standardized health plans to over 1.3 million consumers. California's success with the ACA is largely attributable to its historical receptiveness to health reform; its early adoption of the law; its decision to have Covered California operate as an active purchaser, help shape the plans sold through the marketplace, and design a consumer-friendly enrollment experience; its engagement with stakeholders and community partners to encourage enrollment; and Covered California's commitment to continually innovate, improve, and anticipate the needs of the individual market as the law moves forward.

Modeling the Impact of the Affordable Care Act and the Individual Mandate on Californians

2013 ◽  
Vol 34 (1) ◽  
pp. 16-28 ◽  
Author(s):  
Dylan H. Roby ◽  
Greg Watson ◽  
Ken Jacobs ◽  
Dave Graham-Squire ◽  
Christina M. Kinane ◽  
...  
Keyword(s):  
Affordable Care Act ◽  
Individual Mandate ◽  
The Affordable Care Act ◽  
The Individual ◽  
The Impact

scholarly journals Suspect Spheres, Not Enumerated Powers: A Guide for Leaving the Lamppost

2021 ◽  
pp. 1431
Author(s):  
Richard Primus ◽  
Roderick Hills Jr
Keyword(s):  
Affordable Care Act ◽  
State Level ◽  
The United States ◽  
Federal Legislation ◽  
Federal Law ◽  
National Politics ◽  
Current Century ◽  
Individual Mandate ◽  
Private Corporations ◽  
The Individual

Despite longstanding orthodoxy, the Constitution’s enumeration of congressional powers does virtually nothing to limit federal lawmaking. That’s not because of some bizarrely persistent judicial failure to read the Constitution correctly. It’s because the enumeration of congressional powers is not a well-designed technology for limiting federal legislation. Rather than trying to make the enumeration do work that it will not do, decisionmakers should find better ways of thinking about what lawmaking should be done locally rather than nationally. This Article suggests such a rubric, one that asks not whether Congress has permission to do a certain thing but whether a certain kind of lawmaking is more prone to pathology at the national or the state level. That inquiry could identify “suspect spheres”: areas of policymaking where federal law calls for more justification than elsewhere. Federal legislation within suspect spheres would not necessarily be subject to judicial invalidation, but the judgment that legislation falls within a suspect sphere could underwrite softer forms of judicial resistance to nationalization. We illustrate the suspect-spheres model with a principle of federalism we call the corporate nondelegation doctrine, by which federal delegations of power to private corporations are to be treated skeptically. Early on, that principle animated Madison’s opposition to the Bank of the United States and much of the Jacksonian approach to federalism. It later underwrote the Supreme Court’s decision in Schechter Poultry. In the current century, the idea that the corporate nondelegation doctrine defines a suspect sphere helps explain otherwise puzzling judicial behaviors in federalism cases, including the presumption against preemption and the resistance to the individual mandate of the Affordable Care Act. By illustrating the possibility of a suspect-sphere approach, we suggest a tool that might be useful at a time of destructively polarized national politics, when rubrics for allocating some polarizing issue spaces to state-level decisionmakers might help lower the national temperature.

scholarly journals Health Insurance Coverage before and after the Affordable Care Act in the USA

Sci ◽  
2021 ◽  
Vol 3 (2) ◽  
pp. 25
Author(s):  
Jesse Patrick ◽  
Philip Q. Yang
Keyword(s):  
Health Insurance ◽  
National Health ◽  
Affordable Care Act ◽  
The United States ◽  
Insurance Status ◽  
Health Insurance Status ◽  
Full Implementation ◽  
Before And After ◽  
The Affordable Care Act ◽  
Partial Implementation

The Affordable Care Act (ACA) is at the crossroads. It is important to evaluate the effectiveness of the ACA in order to make rational decisions about the ongoing healthcare reform, but existing research into its effect on health insurance status in the United States is insufficient and descriptive. Using data from the National Health Interview Surveys from 2009 to 2015, this study examines changes in health insurance status and its determinants before the ACA in 2009, during its partial implementation in 2010–2013, and after its full implementation in 2014 and 2015. The results of trend analysis indicate a significant increase in national health insurance rate from 82.2% in 2009 to 89.4% in 2015. Logistic regression analyses confirm the similar impact of age, gender, race, marital status, nativity, citizenship, education, and poverty on health insurance status before and after the ACA. Despite similar effects across years, controlling for other variables, youth aged 26 or below, the foreign-born, Asians, and other races had a greater probability of gaining health insurance after the ACA than before the ACA; however, the odds of obtaining health insurance for Hispanics and the impoverished rose slightly during the partial implementation of the ACA, but somewhat declined after the full implementation of the ACA starting in 2014. These findings should be taken into account by the U.S. Government in deciding the fate of the ACA.

The Impact of the Affordable Care Act Medicaid Expansions on the Sources of Health Insurance Coverage of Undergraduate Students in the United States

2021 ◽  
pp. 107755872110158
Author(s):  
Priyanka Anand ◽  
Dora Gicheva
Keyword(s):  
United States ◽  
Health Insurance ◽  
Undergraduate Students ◽  
Affordable Care Act ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Percentage Points ◽  
The Affordable Care Act ◽  
Medicaid Expansions

This article examines how the Affordable Care Act Medicaid expansions affected the sources of health insurance coverage of undergraduate students in the United States. We show that the Affordable Care Act expansions increased the Medicaid coverage of undergraduate students by 5 to 7 percentage points more in expansion states than in nonexpansion states, resulting in 17% of undergraduate students in expansion states being covered by Medicaid postexpansion (up from 9% prior to the expansion). In contrast, the growth in employer and private direct coverage was 1 to 2 percentage points lower postexpansion for students in expansion states compared with nonexpansion states. Our findings demonstrate that policy efforts to expand Medicaid eligibility have been successful in increasing the Medicaid coverage rates for undergraduate students in the United States, but there is evidence of some crowd out after the expansions—that is, some students substituted their private and employer-sponsored coverage for Medicaid.

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