Over the last five years, many states have sought to limit access to Medicaid by
adopting restrictive policies. How can we reconcile this development with
studies that imply that Medicaid should be ...insulated from policy backlash? The
answer lies in understanding the policy feedback effects that accompanied
Medicaid expansion and how these effects created electoral pressure that led to
policy modification. We situate our expectations within a policy diffusion
framework that accounts for variation in both the content and timing of policy
adoptions across states. We develop and test several hypotheses using survey
data and an original dataset on gubernatorial support for Medicaid work
requirements. Our hypotheses are generally supported and provide a more nuanced
understanding of the policy feedback effects following Medicaid expansion.
The Patient Protection and Affordable Care Act (PPACA), called the Affordable Care Act (ACA) or “ObamaCare” for short, was enacted in 2010. The Public Policy and Advocacy Committee of the Society for ...Surgery of the Alimentary Tract (SSAT) hosted a debate with an expert panel to discuss the ACA and its impact on surgical care after the first year of patient enrollment. The purpose of this debate was to focus on the impact of ACA on the public and surgeons. At the core of the ACA are insurance industry reforms and expanded coverage, with a goal of improved clinical outcomes and reduced costs of care. We have observed supportive and opposing views on ACA. Nonetheless, we will witness major shifts in health care delivery as well as restructuring of our relationship with payers, institutions, and patients. With the rapidly changing health care landscape, surgeons will become key members of health systems and will likely need to lead transition from solo-practice to integrated care systems. The full effects of the ACA remain unrealized, but its implementation has begun to change the map of the American health care system and will surely impact the practice of surgery. Herein, we provide a synopsis of the “pro” and “con” arguments for the expected and unexpected consequences of the ACA on society and surgeons.
Abstract Purpose We conducted a comparative study of how state-level political stakeholders affected the implementation of 3 major reforms within the Patient Protection and Affordable Care Act (ACA). ...Our goal was to analyze the effects of policy legacy, institutional fragmentation, and public sentiments on state obstruction of the reform. Methods We gathered quantitative and qualitative evidence to generate cross-case comparisons of state implementation of 3 reform streams within the ACA: health insurance exchanges, Medicaid expansion, and regulatory reform. Our sources included secondary literature, analysis of official decisions, and background interviews with experts and public officials. Findings We found that state-level opponents of the ACA were most likely to be successful in challenging reforms with few preexisting policy legacies, high institutional fragmentation, and negative public sentiments. Reforms that built on existing state legislation, avoided state veto points or offered lucrative fiscal incentives, and elicited less negative public reaction were less likely to be contested. Implications Our findings point to the importance of institutional design for the role of political stakeholders in implementing reforms to improve the cost, quality, and availability of medical treatments. Although other research has found that political polarization has shaped early ACA outcomes, comparative analysis suggests political stakeholders have had the highest effect on reforms that were particularly vulnerable.
In the USA, universal coverage has long been a key objective of liberal reformers. Yet, despite the enactment of the Patient Protection and Affordable Care Act (PPACA) (commonly known as ‘Obamacare’) ...in 2010, the USA is not set to provide health care coverage to all, even if and when that reform is fully implemented. This article explores this issue by asking the following question: Why was a clear commitment to universal coverage, the norm in other industrialized countries, excluded as a core objective of the PPACA and how has post‐enactment politics at both the federal and the state level further shaped coverage issues? The analysis traces the issue of universal coverage prior to the debate over the PPACA, during the 2008 presidential race, and during consideration of the bill. The article then looks at the post‐enactment politics of coverage, with a particular focus on how states have responded to the planned use of the Medicaid programme to expand access to care. The article concludes by discussing how an explanation of the limits of the PPACA, in terms of both its commitment to universal coverage and, more importantly, the failure to provide comprehensive health insurance to all, requires an understanding of complex institutional and policy dynamics.
The purpose of this article was to examine the effect that higher wages and health care benefits have on costs and prices in limited-service restaurants. In order to compensate for higher wages, ...prices would have to increase between 4 and 25% and/or product size would have to be scaled back between 12 and 70%. With tax credits that are available in the next few years, the Affordable Care Act will have a minimal effect on limited-service restaurants with fewer than 25 full-time equivalent employees. The extent to which higher wages and more benefits will help ameliorate turnover must be balanced with the cost of turnover and the potential effect on sales.
No abstract available. Article truncated at 150 words. On Friday, November 11, President-elect Trump proposed a healthcare agenda on his website greatagain.gov (1). Yesterday, November 12, he gave an ...interview on 60 Minutes clarifying his positions (2). Trump said that he wanted to focus on healthcare and has proposed to: •Repeal all of the Affordable Care Act; •Allow the sale of health insurance across state lines; •Make the purchase of health insurance fully tax deductible; •Expand access to the health savings accounts;•Increase price transparency; •Block grant Medicaid; •Lower entrance barriers to new producers of drugs. In his 60 Minutes interview Trump reiterated that two provisions of the ACA – prohibition of pre-existing conditions exclusion and ability for adult children to stay on parents insurance plans until age 26 – have his support (2). Other aspects of the ACA that might receive his support were not discussed. On the Department of Veterans’ Affairs ...
No abstract available. Article truncated at 150 words. Yesterday (7/17), two additional Senators – Sen. Roberts (R-KS) and Sen. Lee (R-NE) joined Senators Paul (R-KY) and Collins (R-ME) in announcing ...their intention to vote “no” on the motion to proceed on considering the Senate ACA repeal and replace legislation – effectively blocking Senate consideration of the current Senate Republican health care bill. Senators Paul, Lee and Roberts opposed the bill for not going far enough, while Senator Collins expressed her concern the bill goes too far. With the 4 publicly announced NO votes – Senator Majority Leader Mitch McConnell does not have the 50 votes needed to begin debate on the bill, let alone assure final passage. Speculation now turns to what happens next. President Trump has tweeted his preference to let Obamacare fail as a way to force Democrats to negotiate new legislation. Senator McConnell has suggested a series of symbolic votes on full repeal with multi-year delay to work …
No abstract available. Article truncated after first 150 words. Today, the Senate Republican leadership released a revised version of a bill to repeal and replace the Affordable Care Act (ACA). The ...new bill draft includes an amendment sponsored by Sen. Cruz (R-TX) that permits insurers to offer health insurance plans on the ACA exchanges that do not cover the ACA’s 10 essential health benefits (EHB) as long as they offer at least one other plan that provides full coverage of EHB’s. The bill also includes more funding for opioid addiction and for state initiatives to reduce insurance premiums and additionally, some flexibility for state Medicaid funding in the event of a public health crisis. The bill must still receive a cost estimate from the Congressional Budget Office (CBO), which will include the impact of the bill on insurance coverage levels, expected out Monday. The ATS remains deeply concerned about the bill because under the Cruz proposal, insurance coverage costs …
No abstract available. Article truncated after 150 words. The New York Times is reporting that all of Arizona, much of Nevada, and portions of Utah and Colorado will have only one insurer available ...under the Affordable Care Act (ACA, Obamacare) marketplace (Figure 1) (1). About 35,000 people buying insurance in Affordable Care Act marketplaces in 45 counties could have no choice in carriers in Ohio and Missouri (Figure 1), This would be the first time that has happened since the marketplaces were opened in 2014. Some insurance companies are still deciding what they will do in 2018, and others may reverse course, so these numbers could go up or down. Most Americans get health insurance from a job or government program, but about 22 million people buy individual policies under Obamacare. More than half of them use Obamacare marketplaces, where most of them get a federal tax credit to help pay for coverage. The rest buy directly from …
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