The ACA's Choice Problem

2020 ◽  
Vol 45 (4) ◽  
pp. 501-515
Author(s):  
Allison K. Hoffman
Keyword(s):  
Health Care ◽  
Health Policy ◽  
Affordable Care Act ◽  
Access To Health Care ◽  
Care Delivery ◽  
Health Plans ◽  
Vicious Cycle ◽  
Love Affair ◽  
Policy Theory ◽  
Access To Health

Abstract The Affordable Care Act (ACA) is in many ways a success. Millions more Americans now have access to health care, and the ACA catalyzed advances in health care delivery reform. Simultaneously, it has reinforced and bolstered a problem at the heart of American health policy and regulation: a love affair with choice. The ACA's insurance reforms doubled down on the particularly American obsession with choice. This article describes three ways in which that doubling down is problematic for the future of US health policy. First, pragmatically, health policy theory predicts that choice among health plans will produce tangible benefits that it does not actually produce. Most people do not like choosing among health plan options, and many people—even if well educated and knowledgeable—do not make good choices. Second, creating the regulatory structures to support these choices built and reinforced a massive market bureaucracy. Finally, and most important, philosophically and sociologically the ACA reinforces the idea that the goal of health regulation should be to preserve choice, even when that choice is empty. This vicious cycle seems likely to persist based on the lead up to the 2020 presidential election.

scholarly journals Compact for care: how the Affordable Care Act marketplaces fell short for a vulnerable population in Hawaii

2021 ◽  
Vol 6 (11) ◽  
pp. e007701
Author(s):  
Joshua S Ng Kamstra ◽  
Teresa Molina ◽  
Timothy Halliday
Keyword(s):  
Health Care ◽  
Affordable Care Act ◽  
Access To Health Care ◽  
Care Delivery ◽  
Free Association ◽  
Marshall Islands ◽  
Health Coverage ◽  
Government Programs ◽  
Access To Health ◽  
The Usa

The Patient Protection and Affordable Care Act (ACA) was passed in 2010 to expand access to health insurance in the USA and promote innovation in health care delivery. While the law significantly reduced the proportion of uninsured, the market-based protection it provides for poor and vulnerable US residents is an imperfect substitute for government programs such as Medicaid. In 2015, residents of Hawaii from three Compact of Free Association nations (the Federated States of Micronesia, Palau and Marshall Islands) lost their eligibility for the state’s Medicaid program and were instructed to enrol in coverage via the ACA marketplace. This transition resulted in worsened access to health care and ultimately increased mortality in this group. We explain these changes via four mechanisms: difficulty communicating the policy change to affected individuals, administrative barriers to coverage under the ACA, increased out of pocket health care costs and short enrolment windows. To achieve universal health coverage in the USA, these challenges must be addressed by policy-makers.

Health Policy in Cambodia: To What Extent Is an Aid-Dependent Country Able to Determine Its Own Policy?

2014 ◽  
Vol 44 (1) ◽  
pp. 171-187 ◽  
Author(s):  
VIRGINIE DIAZ PEDREGAL ◽  
BLANDINE DESTREMAU ◽  
BART CRIEL
Keyword(s):  
Health Care ◽  
Health Policy ◽  
Low Income ◽  
Access To Health Care ◽  
Implementation Process ◽  
Health Care Provision ◽  
Care Provision ◽  
Low Income Country ◽  
Access To Health ◽  
Wide Range

AbstractThis article analyses the design and implementation process of arrangements for health care provision and access to health care in Cambodia. It points to the complexity of shaping a coherent social policy in a low-income country heavily dependent on international aid.At a theoretical level, we confirm that ideas, interests and institutions are all important factors in the construction of Cambodian health care schemes. However, we demonstrate that trying to hierarchically organise these three elements to explain policy making is not fruitful.Regarding the methodology, interviews with forty-eight selected participants produced the qualitative material for this study. A documentary review was also an important source of data and information.The study produces two sets of results. First, Cambodian policy aimed at the development of health care arrangements results from a series of negotiations between a wide range of stakeholders with different objectives and interests. International stakeholders, such as donors and technical organisations, are major players in the policy arena where health policy is constructed. Cambodian civil society, however, is rarely involved in the negotiations.Second, the Cambodian government makes political decisions incrementally. The long-term vision of the Cambodian authorities for improving health care provision and access is quite clear, but, nevertheless, day-to-day decisions and actions are constantly negotiated between stakeholders. As a result, donors and non-government organisations (NGOs) working in the field find it difficult to anticipate policies.To conclude, despite real autonomy in the decision-making process, the Cambodian government still has to prove its capacity to master a number of risks, such as the (so far under-regulated) development of the private health care sector.

Insurance Type and Access to Health Care Providers and Appointments Under the Affordable Care Act

Medical Care ◽  
2018 ◽  
Vol 56 (2) ◽  
pp. 186-192 ◽  
Author(s):  
Héctor E. Alcalá ◽  
Dylan H. Roby ◽  
David T. Grande ◽  
Ryan M. McKenna ◽  
Alexander N. Ortega
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Affordable Care Act ◽  
Access To Health Care ◽  
Care Providers ◽  
Insurance Type ◽  
Access To Health ◽  
The Affordable Care Act

Has China’s Health Sector Development Matched the Rapid Growth in the Country?

2017 ◽  
Vol 13 (36) ◽  
pp. 1
Author(s):  
Marta Tripane
Keyword(s):  
Health Care ◽  
Health Policy ◽  
Empirical Data ◽  
Access To Health Care ◽  
Health Sector ◽  
The Third ◽  
Health Area ◽  
Access To Health ◽  
The World ◽  
Unequal Access

China is the world's largest country by population, the third largest by territory and the second largest world’s economy by GDP. Therefore it is important to follow the successes and failures of China in the field of health, because they affect the health area and processes in the world. This article includes retrospective analysis of empirical data to analyze the main inputs and outputs of China's health policy in order to identify the main problems and highlight the major challenges. In the article is concluded that main problems are related with insufficient and unequal access to health care.

Opportunities for Oncology in the Patient Protection and Affordable Care Act

2013 ◽  
pp. 436-440
Author(s):  
Kavita K. Patel ◽  
Lisa Tran
Keyword(s):  
Health Care ◽  
Affordable Care Act ◽  
Access To Health Care ◽  
Improve Quality ◽  
Triple Aim ◽  
Patient Protection ◽  
Access To Health ◽  
Improve Health

The Patient Protection and Affordable Care Act (ACA) contains within it three significant legislative constructs: to enhance access to health care, improve quality, and decrease cost. Also known as the Triple Aim, these three simple, yet monumental, goals have been the object of actions to date as well as future implementation efforts. This article will identify sections of the legislation that would directly provide areas of opportunity to improve health and achieve the triple aim for the oncology profession.

scholarly journals The Implementation and Evaluation of the United States Affordable Care Act

2019 ◽  
Vol 12 (1) ◽  
pp. 17-38
Author(s):  
David Schultz
Keyword(s):  
United States ◽  
Health Care ◽  
Affordable Care Act ◽  
Access To Health Care ◽  
Care Delivery ◽  
The United States ◽  
Health Care Delivery System ◽  
Health Care Outcomes ◽  
The Us ◽  
American Health Care

In 2010 the United States Congress adopted the Patient Protection and Affordable Care Act (“ACA”), more commonly referred to as Obamacare. The ACA was proposed by President Barack Obama while running for president and it was passed with a near straight party-line vote of Democrats in the US House and Senate in 2010. The ACA was meant to address several problems with the American health care delivery system, including cost, access and outcomes. This article describes the major features of the ACA including the context of the US health care system, evaluates the ACA’s implementation history and assesses its fate and future reforms throughout the presidency of Donald Trump. The overall conclusion based on its implementation is that while the ACA made significant reforms in terms of access to health care, it is not clear that it addressed affordability or began to improve health care outcomes in the US.

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