Beyond Coverage and Controversy: The ACA’s Distinctly American Approach to Healthcare Coverage and Reform

Abstract

The number of Americans who lacked health insurance coverage remained high prior to the passage of the Affordable Care Act (ACA) of 2010 (Cohen et al. Health insurance coverage: early release of estimates from the National Health Insurance, 2018. Atlanta: Centers for Disease Control; 2019). By 2016, over 20 million people gained coverage as a result of the law (Garrett and Gangopadhyaya. Who gained health insurance coverage under the ACA and where do they live? Washington: Urban Institute; 2016). Several key provisions, such as the Medicaid expansion and mandate for individuals to maintain health insurance coverage, have been controversial and challenged in federal court (see Chap. 8). While coverage gains and court challenges dominated headlines about the law in the first decade, other features of the ACA—such as its legislative history and approach to improving the value of healthcare delivered in the United States—are distinctive and worthy of a closer look. These and other features of ACA demonstrate that US policymakers can move closer to the goals of universal coverage and affordable cost for patients while deploying a distinctly American approach to achieving them.