An Economic Perspective on the Affordable Care Act: Expectations and Reality

Sayeh Nikpay, India Pungarcher, and I have published a paper in the Journal of Health Politics, Policy and Law on the economics of the ACA — what it was expected to do and what it actually did.

The Affordable Care Act (ACA) was enacted in 2010 to address both high uninsured rates and rising health care spending through insurance expansion reforms and efforts to reduce waste. It was expected to have a variety of impacts in areas within the purview of economics, including effects on health care coverage, access to care, financial security, labor market decisions, health, and health care spending. To varying degrees, legislative, executive, and judicial actions have altered its implementation, affecting the extent to which expectations in each of these dimensions have been realized. We review the ACA’s reforms, the subsequent actions that countered them, and the expected and realized effects on coverage, access to care, financial security, health, labor market decisions, and health care spending.

We thank the National Heart, Lung, and Blood Institute and the Laura and John Arnold Foundation for support during this work, as well as the invitation of the paper and skillful editing of it by Jonathan Oberlander.

The full PDF is here.


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