The US Affordable Care Act: Reflections and directions at the close of a decade

Abstract:

Nearly nine years after its passage, the Affordable Care Act (ACA) remains at the forefront of public policy debate. The law is persistently contentious as a matter of public opinion, but represents a historic achievement in United States healthcare reform. While it was incremental in many respects—health insurance plans for the vast majority of Americans were relatively unchanged—the ACA left an indelible mark on the healthcare system through its expansion of insurance coverage and efforts to improve the healthcare delivery system. In the past decade, the country has witnessed a substantial decline in the number of uninsured individuals, while other elements of the law have sought to make inroads into affecting the cost and quality of care. Yet looking forward, the ACA continues to face challenges that make its abiding impact and legacy uncertain.