Abstract The Patient Protection and Affordable Care Act (ACA) was passed by a Democratic Congress and signed into law by a Democratic president in 2010. Republican congressmen, governors, and ...Republican candidates have consistently opposed the ACA and have vowed to repeal it. Polls have consistently shown that it is supported by <50% of Americans. The most important goal of the ACA is to improve the health of Americans by increasing the number covered by health insurance. In the first year of its implementation, more than 10 million citizens gained health insurance. The percentage of Americans without health insurance decreased from 18% in July 2013 to 13.4% in June 2014. In addition, the ACA has eliminated many of the negative features of private insurance such as the denial of coverage for those with “prior conditions.” The benefits of Medicare have been enhanced to decrease the cost of prescription drugs and to eliminate co-pays for preventive services. Despite these positive changes, a near majority of Americans still oppose the ACA, even though they approve of most of its features. They oppose the mandate that all Americans must have health insurance (the individual mandate), and they oppose a government role in health care. Yet Medicare, a mandatory insurance for seniors administered by the federal government since 1965, is overwhelmingly approved by the American public. The opposition to a government role in health care is based on the fact that that the vast majority of our citizens do not trust their government. Republicans are much less trusting of the federal government and much less supportive of a government role in health care than Democrats. The overwhelmingly negative TV ads against the ACA by the Republican candidates in the elections of 2012 and 2014 have had a major impact on Americans' views of the ACA. More than 60% of Americans have stated that most of what they know about the ACA came from watching TV. Opposition to a government role in health care and to mandatory health insurance makes it unlikely that the US will be able to insure that all of its citizens have ongoing access to health care in the near future.
In this study, we compared the social media net sentiment of one policy with two names. Specifically, we analyzed Obamacare and the Affordable Care Act (ACA) to understand how social media users ...engaged with each term on social media from March 2010 to March 2017. The net sentiment was measured with a sample of over 50 million micro-blogs, and the analysis was done using a combination of digital instruments and human validation. We found a significant difference between the social media engagement and sentiment of both terms, with the ACA performing significantly better than Obamacare, despite Obamacare's higher conversation volume. With the ACA having an average of 26% less negative sentiment than Obamacare, the findings of this study emphasize the need to be careful when attaching nicknames to public policy. The findings also have implications for policymakers and politicians.
The Affordable Care Act (ACA) expanded Medicaid eligibility to persons with income up to 138% of the federal poverty line. We investigated how Medicaid expansion (ME) impacted the access to ...cancer-specific surgical care in the US.
We used a nationwide population-based database (SEER) to identify patients with the 8 most prevalent cancers between 2007 and 2015. Adjusted difference-in-differences (DiD) and multivariate regression were used for statistical analysis.
A total of 1,008,074 patients were included. Patients post-ME were diagnosed at an earlier stage (pre-ME, 27.6%; post-ME, 31.1%; P < 0.001), and lack of insurance coverage decreased from 5.5% to 2.6% (P < 0.001). Lower-SES population had improved access to surgical care (attributable benefit +3.18%; P < 0.001). ME was an independent predictor of access-to-surgery (OR, 1.45; P < 0.001), whereas African-American and Hispanic race were negative predictive factors.
After ME, the population without insurance coverage decreased. This was associated with earlier cancer diagnosis and improved access to surgery in patients from economically disadvantaged communities.
•The Affordable Care Act extended Medicaid eligibility in the United States.•A higher proportion of cancer patients was diagnosed at an early stage after Medicaid expansion.•Cancer patients living in poor counties had improved access to surgical care.•African American and Hispanic patients still have lower chances to undergo surgical treatment.
The Affordable Care Act (ACA), of 2010, or Obamacare, was the most monumental change in US health care policy since the passage of Medicaid and Medicare in 1965. Since its enactment, numerous claims ...have been made on both sides of the aisle regarding the ACA's success or failure; these views often colored by political persuasion. The ACA had 3 primary goals: increasing the number of the insured, improving the quality of care, and reducing the costs of health care. One point often lost in the discussion is the distinction between affordability and access. Health insurance is a financial mechanism for paying for health care, while access refers to the process of actually obtaining that health care. The ACA has widened the gap between providing patients the mechanism of paying for healthcare and actually receiving it. The ACA is applauded for increasing the number of insured, quite appropriately as that has occurred for over 20 million people. Less frequently mentioned are the 6 million who have lost their insurance. Further, in terms of how health insurance is been provided, the majority the expansion was based on Medicaid expansion, with an increase of 13 million. Consequently, the ACA hasn't worked well for the working and middle class who receive much less support, particularly those who earn more than 400% of the federal poverty level, who constitute 40% of the population and don't receive any help. As a result, exchange enrollment has been a disappointment and the percentage of workers obtaining their health benefits from their employer has decreased steadily. Access to health care has been uneven, with those on Medicaid hampered by narrow networks, while those on the exchanges or getting employer benefits have faced high out-of-pocket costs.The second category relates to cost containment. President Obama claimed that the ACA provided significant cost containment, in that costs would have been even much higher if the ACA was not enacted. Further, he attributed cost reductions generally to the ACA, not taking into account factors such as the recession, increased out-of-pocket costs, increasing drug prices, and reduced coverage by insurers.The final goal was improvement in quality. The effort to improve quality has led to the creation of dozens of new agencies, boards, commissions, and other government entities. In turn, practice management and regulatory compliance costs have increased. Structurally, solo and independent practices, which lack the capability to manage these new regulatory demands, have declined. Hospital employment, with its associated increased costs, has been soaring. Despite a focus on preventive services in the management of chronic disease, only 3% of health care expenditures have been spent on preventive services while the costs of managing chronic disease continue to escalate.The ACA is the most consequential and comprehensive health care reform enacted since Medicare. The ACA has gained a net increase in the number of individuals with insurance, primarily through Medicaid expansion. The reduction in costs is an arguable achievement, while quality of care has seemingly not improved. Finally, access seems to have diminished.This review attempts to bring clarity to the discussion by reviewing the ACA's impact on affordability, cost containment and quality of care. We will discuss these aspects of the ACA from the perspective of proponents, opponents, and a pragmatic point of view.Key words: Affordable Care Act (ACA), Obamacare, Medicare, Medicaid, Medicare Modernization Act (MMA), cost of health care, quality of health care, Merit-Based Incentive Payments System (MIPS).
Despite passage of the Affordable Care Act in 2010, the U.S. health care crisis continues. While coverage has been expanded, the reform will leave 27 million people uninsured in 2024, according to ...the Congressional Budget Office. Much of the new coverage is of low actuarial value with high cost-sharing requirements, creating barriers to access. Choice of physician is restricted to narrow networks of providers. Recent measures of uninsurance, underinsurance, access to care, and health care costs are given. Changes in Medicare, particularly privatization and the rise of specialty drug tiers that limit access to medically necessary medications, are reviewed. Data on a new wave of consolidation among hospitals, medical groups, insurers, and drug companies are presented. The rise of ultra-high-price drugs, such as Solvadi, is raising pharmaceutical costs, particularly in Medicaid, the program for low-income Americans. International health comparisons continue to show the United States performing poorly in relation to other countries. Recent polling data are presented, showing support for more fundamental reform.
A content analysis (N = 520) of Affordable Care Act (ACA) coverage in The New York Times (NYT) examined the use of frames and exemplars to understand how the ACA was covered from passage through ...repeal attempts in 2017. Results show an increase in episodic frames as the law took effect and citizens faced health coverage decisions. There was also a change in NYT use of exemplars over the years. In the earlier stage of the ACA, the exemplars featured elites such as politicians, but later focusing more on citizen experiences and the benefits of the ACA. Findings suggest the change in how the NYT framed the ACA increasingly involved personal stories about the law's benefits as well as the public's experiences.
Can data-driven innovations, working across an internet of connected things, personalize health insurance prices? The emergence of self-tracking technologies and their adoption and promotion in ...health insurance products has been characterized as a threat to solidaristic models of healthcare provision. If individual behaviour rather than group membership were to become the basis of risk assessment, the social, economic and political consequences would be far-reaching. It would disrupt the distributive, solidaristic character that is expressed within all health insurance schemes, even in those nominally designated as private or commercial. Personalized risk pricing is at odds with the infrastructures that presently define, regulate and deliver health insurance. Self-tracking can be readily imagined as an element in an ongoing bio-political redistribution of the burden of responsibility from the state to citizens but it is not clear that such a scenario could be delivered within existing individual private health insurance operational and regulatory infrastructures. In what can be gleaned from publicly available sources discussing pricing experience in the individual markets established by the Patient Protection and Affordable Care Act 2010 (ACA), widely known as 'Obamacare', it appears unlikely that it can provide the means to personalize price. Using the case of Oscar Health, a technology driven start-up trading in the ACA marketplaces, I explore the concepts, politics and infrastructures at work in health insurance markets.
Louisiana was the first state in the Deep South to adopt the Patient Protection and Affordable Care Act (ACA) Medicaid expansion. In this issue of Cancer, Chu et al present the positive impact of the ...ACA expansion on women with breast cancer who reside in Louisiana, including increased adherence to the standard of care and an earlier stage of disease at the time of presentation.
ABSTRACT
Described by many as an emotional state rooted in having been treated unfairly, resentment has surged over the past decade. Resentment politics troubled the passage and implementation of the ...Affordable Care Act (ACA, 2010) in the United States. While some people gained access to health insurance through the ACA, others experienced continued exclusion from affordable coverage. Drawing on ethnographic interviews with poor whites from Florida, Rhode Island, and Texas, we show how uninsured individuals talked about and experienced resentment through contradictory tropes of “us versus them,” deservingness, and personal responsibility. We argue that policies based in resentment, occurring on both national and state levels, structured these individuals’ experiences and amplified their resentment sentiments. Through this case study we argue that resentment is more than an emotion: it is also a force that structures policies and their implementation. Resentment policies in turn create the social, political, and economic circumstances that generate resentment feelings.
There is a large body of literature devoted to how “policies create politics” and how feedback effects from existing policy legacies shape potential reforms in a particular area. Although much of ...this literature focuses on self‐reinforcing feedback effects that increase support for existing policies over time, Kent Weaver and his colleagues have recently drawn our attention to self‐undermining effects that can gradually weaken support for such policies. The following contribution explores both self‐reinforcing and self‐undermining policy feedback in relationship to the Affordable Care Act, the most important health‐care reform enacted in the United States since the mid‐1960s. More specifically, the paper draws on the concept of policy feedback to reflect on the political fate of the ACA since its adoption in 2010. We argue that, due in part to its sheer complexity and fragmentation, the ACA generates both self‐reinforcing and self‐undermining feedback effects that, depending of the aspect of the legislation at hand, can either facilitate or impede conservative retrenchment and restructuring. Simultaneously, through a discussion of partisan effects that shape Republican behavior in Congress, we acknowledge the limits of policy feedback in the explanation of policy stability and change.
有大量文献专门讨论“政策如何创造政治”以及现有政策研究传统中的反馈效应如何构建特定领域内的潜在改革这类问题。这些文献中的大部分都集中在自增强的反馈效应上，其表现为随着时间的推移而增加对现有政策的支持，但Kent Weaver及其同事最近让我们注意到了自削弱效应，这种效应可以逐渐减少对这些政策的支持。“平价医疗法案”（Affordable Care Act）是自20世纪60年代中期以来美国颁布的最重要的医疗改革法案，下文探讨了与之相关的自强化和自削弱的政策反馈。更具体地说，本文借鉴了政策反馈的概念，来反映ACA自 2010年得到通过之后的政治命运。我们认为，由于其强烈的复杂性和分散性，ACA产生了自强化和自削弱两种反馈效应，至于产生哪一种反馈效应，这取决于当前立法是可以促进还是阻碍保守的紧缩与结构调整。同时，通过讨论影响共和党在国会中行为的党派效应，我们承认了政策反馈在解释政策的稳定和变革时的局限性。
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