Abstract
This paper asks whether the Patient Protection and Affordable Care Act achieves its goals of significantly expanding health insurance coverage, while reducing costs and increasing the quality of the care provided. An examination of the early results and current future projections suggests that while PPACA will increase the number of Americans with health insurance, it will fall significantly short of universal coverage. In addition, PPACA fails to control health care costs, and will likely result in higher costs for government, as well as many businesses, and individuals. The author concludes that PPACA is not the most effective vehicle for achieving US health care reform, and that a more market-oriented approach offers a better alternative.
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American Association of Medical Colleges. (2010). Physician shortages to worsen without increases in residency training. https://www.aamc.org/download/150584/data/physician_shortages_factsheet.pdf. Accessed 12 April 2012.
Blahous, C. (2012). The Fiscal Consequences of the Affordable Care Act. Mercatus Center. http://mercatus.org/sites/default/files/publication/The-Fiscal-Consequences-of-the-Affordable-Care-Act_1.pdf. Accessed 24 April 2012.
Center for Medicare and Medicaid Services. (2012). National Health Expenditure Projections 2011–2021. www.cms.gov/.../NationalHealthExpendData/.../Proj2011PDF.pdf. Accessed 24 April 2012.
Coleman, M. P., Quaresma, M., Berrino, F., Lutz, J. M., De Angelis, R., Capocaccia, R., Young, J.L. (2008). Cancer survival on five continents: A worldwide population-based study. The Lancet Oncology, 9(8), 730–756. http://healthcare.procon.org/sourcefiles/CONCORDCancerSurvivalStudy.pdf.
Congressional Budget Office. (2008). Key Issues in Analyzing Major Health Proposals. Washington, DC: US Government Printing Office. http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/99xx/doc9924/12-18-keyissues.pdf. Accessed 30 March 2012.
Congressional Budget Office. (2008). Budget Options Volume 1: Health Care, Chapt. 7, p. 119. Washington, DC: US Government Printing Office. http://www.cbo.gov/publication/41747.
Congressional Budget Office. (2011). Additional Information About CBO’s Baseline Projections of Federal Subsidies for Health Insurance Provided Through Exchanges. Washington, DC: US Government Printing Office. http://cbo.gov/sites/default/files/cbofiles/ftpdocs/121xx/doc12119/03-30-healthcarelegislation.pdf. Accessed 15 April 2012.
Congressional Budget Office. (2012a). Lessons from Medicare’s Demonstration Projects on Disease Management, Care Coordination, and Value-Based Payment. http://www.cbo.gov/publication/42860. Accessed 28 March 2012.
Congressional Budget Office. (2012b). Updated Estimates for the Insurance Coverage Provisions of the Affordable Care Act. p. 2. http://www.cbo.gov/sites/default/files/cbofiles/attachments/03-13-Coverage%20Estimates.pdf. Accessed 4 April 2012.
Congressional Budget Office. (2012c). The Budget and Economic Outlook Fiscal Years 2012 to 2022. http://www.cbo.gov/publication/42905. Accessed 13 March 2012.
Decker, S. (2012). In 2011 nearly one-third of physicians said they would not accept new medicaid patients, but rising fees may help. Health Affairs August 31(8), 1673–1679. http://content.healthaffairs.org/content/31/8/1673.abstract. Accessed 17 April 2012.
Deloitte LLP. (2012). Deloitte Survey of US Employers: Opinions about the US health care system and plans for employee health benefits. Deloitte Center for Health Solutions and Deloitte Consulting. http://www.deloitte.com/view/en_US/us/Insights/centers/center-for-health-solutions/21c1f310fb8b8310VgnVCM3000001c56f00aRCRD.htm?id=us_furl_chs_employersurvey_072412. Accessed 20 July 2012.
Department of Health and Human Services. (2010). Fact sheet: Keeping the health plan you have: the affordable care act and “Grandfathered plans”. http://www.healthreform.gov/newsroom/keeping_the_health_plan_you_have.html.
Doctor Patient Medical Association Foundation. (2012). Physician attitudes in medicine survey results. Retrieved June 28, 2012 from http://www.doctorsandpatients.org/images/files/DPMA_SurveyResults.pdf. Accessed 28 June 2012.
eHealth Insurance. (2011). Cost and Benefits of Individual & Family Health Insurance Plans. http://news.ehealthinsurance.com/pr/ehi/document/2011_Cost__and__Benefits_Report_FINAL.pdf. Accessed 17 April 2012.
Elmendorf, D. (2010a). Letter to the Honorable Nancy Pelosi providing an estimate for H.R. 4872, Reconciliation Act of 2010. Congressional Budget Office and Joint Committee on Taxation. http://www.cbo.gov/publication/21351. Accessed 20 March 2012.
Elmendorf, D. (2010b). Letter to the Honorable Jerry Lewis providing additional information about the potential effects of H.R. 3590, the Patient Protection and Affordable Care Act on discretionary spending. Congressional Budget Office. http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/114xx/doc11490/lewisltr_hr3590.pdf. Accessed 27 March 2012.
Elmendorf, D. (2011). Testimony before the Subcommittee on Health, Committee on Energy and Commerce on “CBO’s Analysis of the Major Health Care Legislation Enacted in March 2010. Congressional Budget Office. http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/121xx/doc12119/03-30-healthcarelegislation.pdf. Accessed 29 March 2012.
Elmendorf, D. (2012). Letter to the Honorable John Boehner providing an estimate for H.R. 6079, the Repeal of Obamacare Act. Congressional Budget Office and Joint Committee on Taxation.http://www.cbo.gov/sites/default/files/cbofiles/attachments/43471-hr6079.pdf. Accessed 30 July 2012.
Executive Office of the President of the United States. (1999). Analytical Perspectives, Budget of the United States Government, Fiscal Year 2000 (p. 337). Washington, DC: US Government Printing Office. http://govinfo.library.unt.edu/npr/library/omb/budget.pdf. Accessed 3 April 2012.
Feder, J. L. (2012). Birth control controversies multiply. Politico. http://www.politico.com/news/stories/0212/73343.html. Accessed 5 March 2012.
Finklestein, A., Einav, L., Ryan, S. P., Schrimpf, P., & Cullen, M. R. (2011). Selection on moral hazard in health insurance. National Bureau of Economic Research, Working Paper No. 16969. http://www.nber.org/papers/w16969. Accessed 13 March 2012.
Fisher, E., Goodman, D., Skinner, J., & Bronner, K. (2009). Health care spending, quality, and outcomes—More isn’t always better. The Dartmouth Institute for Health Policy and Clinical Practice. http://www.dartmouthatlas.org/downloads/reports/Spending_Brief_022709.pdf. Accessed 10 April 2012.
Foster, R. S. (2011). The estimated effect of the affordable care act on medicare and medicaid outlays and total national health care expenditures, testimony before the house committee on the budget. House Committee on the Budget. http://budget.house.gov/uploadedfiles/fostertestimony1262011.pdf. Accessed 15 March 2012.
Gabel, J. R., Lore, R., McDevitt, R. D., Pickreign, J. D., Whitmore, H., Slover, M., & Levy-Forsythe, E. (2012). More than half of individual health plans offer coverage that falls short of what can be sold through exchanges as of 2014. Health Affairs, 31(6), 1339–1348. http://www.commonwealthfund.org/Publications/In-the-Literature/2012/May/Individual-Health-Plan-Coverage-Falls-Short.aspx. Accessed 5 June 2012.
Gruber, J. (1994). The incidence of mandated maternity benefits. American Economic Review, 84(3), 662–641. http://www.jstor.org/stable/10.2307/2118071. Accessed 4 April 2012.
Helms, R. (2008). Tax policy and the history of the health insurance industry. Paper from Taxes and Health Insurance: Analysis and Policy Conference sponsored by American Tax Policy Institute and Tax Policy Center. http://www.aei.org/files/2008/02/29/healthconference-helms.pdf. Accessed 10 April 2012.
Jackson Healthcare. (2012). A Tough Time for Physicians: 2012 Medical Practice and Attitude Report. http://www.healthcare-informatics.com/news-item/one-third-us-physicians-plan-quit-private-practice-within-10-years. Accessed 10 June 2012.
Jacobe, D. (2012). Health Costs, Gov’t Regulations Curb Small Business Hiring. Gallup. http://www.gallup.com/poll/152654/health-costs-gov-regulations-curb-small-business-hiring.aspx. Accessed 6 March 2012.
Johnson, C. (2010). Health premiums could rise 17 percent for young adults. Associated Press. http://seattletimes.com/html/nationworld/2011474724_healthage30.html. Accessed 6 March 2012.
Kelley, E., & Hurst, J. (2006). Health Care quality indicators project: Initial indicators report. OECD Health working Papers no. 22. http://www.oecd-ilibrary.org/docserver/download/fulltext/5l9t19p99tmv.pdf?expires=1352133657&id=id&accname=guest&checksum=FC681461B9734F23EA64AE637C66ABB9. Accessed 21 March 2012.
King, K. (2011). Medicare: Program remains at high risk because of continuing management challenges,” Testimony before the subcommittee on oversight and investigations. Committee on Energy and Commerce, House of Representatives, Government Accountability Office, 2011. http://www.gao.gov/assets/130/125582.html. Accessed 13 March 2012.
KRC Research. (2012). Senior’s opinions about medicare Rx: 7th year update. A Survey conducted by KRC Research for Medicare Today. http://www.medicaretoday.org/MT2012/KRC%20Survey%20of%20Seniors%20for%20Medicare%20Today%2010%2002%202012.pdf. Accessed 20 September 2012.
Long, S. (2008). On the road to universal coverage: Impacts of reform in Massachusetts. Health Affairs, 27, w270–84. http://content.healthaffairs.org/content/27/4/w270.full.
Manning, W. G., Newhouse, J. P., Duan, N., Keeler, E. B., Leibowitz, A., Marquis, M. S., Zwanziger, J. (1987). Health insurance and the demand for medical care: Evidence from a randomized experiment. American Economic Review, 77, 251–273. http://www.jstor.org/sici?sici=0002-8282%28198706%2977%3A3%3C251%3AHIATDF%3E2.0.CO%3B2-S&origin=repec. Accessed 12 April 2012.
Massachusetts Medical Society. (2011). Patient Access to Health Care Study: A Survey of Massachusetts Physicians’ Offices. http://www.massmed.org/AM/Template.cfm?Section=Home6&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=54338. Accessed 16 April 2012.
National Federation of Independent Business et. al., v. Sebelius, Secretary of Health and Human Services, et. al., 567 US 2 Opinion of Roberts, C.J. (2012). http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf. Accessed 30 June 2012.
National Institute of Statistics and Economic Studies (INSEE). (2011). Les seuils de 10, 20 et 50 salariés: un impact limité sur la taille des entreprises françaises. Paris, France; Author. http://www.insee.fr/fr/ffc/iana/iana2/iana2.pdf. Accessed 26 March 2012.
New, M. J. (2006). The effect of state regulations on health insurance premiums: A revised analysis. The Heritage Foundation. http://www.heritage.org/research/reports/2006/07/the-effect-of-state-regulations-on-health-insurance-premiums-a-revised-analysis. Accessed 4 April 2012.
Newhouse, J. P., Manning, W. G., Morris, C. N., Orr, L. L., Duan, N., Keeler, E. B., Brook, R. H. (1982). Some interim results from a controlled trial of cost sharing in health insurance. Rand Corporation. http://www.rand.org/pubs/reports/2006/R2847.pdf. Accessed 4 April 2012.
Organization for Economic Cooperation and Development (OECD). (2007). OECD Health Data 2007: Statistics and Indicators for 30 Countries.
Parente, S. T., Feldman, R., Abraham, J., Xu, Y. (2008). Consumer response to a national marketplace for individual insurance. University of Minnesota Carlson School of Management. http://aspe.hhs.gov/health/reports/08/consumerresponse/report.html. Accessed 14 March 2012.
Patient Protection and Affordable Health Care Act (PPACA). (2010). Public Law 111-148. http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf.
Public Health Service Act, Title XXVII, Part A, sec. 2705(a)(1-9), as amended by the Patient Protection and Affordable Care Act, Title I, Subtitle C, sec. 1201.
Reinhardt, U., & Krueger, A. (1994). The economics of employer versus individual mandates. Health Affairs, 13(2), 34–53. http://content.healthaffairs.org/content/13/2/34.full.pdf+html. Accessed 4 May 2012.
Reinhart, U., Hussey, P. S., & Anderson, G. F. (2004). US Health care spending in an international context. Health Affairs, 23, 11–12. http://content.healthaffairs.org/content/23/3/10.full.pdf+html. Accessed 10 April 2012.
Reischauer, R. (1994). An analysis of the administration’s health proposal. Congressional Budget Office, February 1994. http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/48xx/doc4882/doc07.pdf.
Ringel, J. S., Girosi, F., Cordova, A., Price, C., McGlynn, E. A. (2010). Analysis of the patient protection and affordable care act, HR 3590. Rand Corporation RB-9514. http://www.rand.org/pubs/research_briefs/RB9514.html. Accessed 28 March 2012.
Sebelius, K. (2012). The Affordable Care Act has made the US health-care system stronger. Washington Post. http://www.washingtonpost.com/opinions/kathleen-sebelius-the-affordable-care-act-has-made-the-us-health-care-system-stronger/2012/07/09/gJQA1BOOZW_story.html. Accessed 12 July 2012.
Singhal, S., Stueland, J., Ungerman, D. (2011). How US health care reform will affect employee benefits. McKinsey & Company. http://www.mckinsey.com/~/media/mckinsey/dotcom/US%20employer%20healthcare%20survey/us_health_benefits.aspx. Accessed 18 April 2012.
Summers, L. (1989). Some simple economics of mandated benefits. The American Economic Review, 79(2), pp. 177–183. Papers and Proceedings of the Hundred and First Annual Meeting of the American Economic Association. http://www.jstor.org/stable/1827753. Accessed 17 April 2012.
Terry, J. (2009). 45 % Of doctors would consider quitting if Congress passes health care overhaul. Investor's Business Daily. Retrieved April 4, 2012 from http://www.investors.com/NewsAndAnalysis/Article.aspx?id=506199.
Tanner, M. (2009). Massachusetts miracle or Massachusetts miserable: What the failure of the “Massachusetts Model” tells us about health care reform. Cato Institute. Briefing Paper No.112.
Tanner, M. (2010). Bad Medicine: A Guide to the Real Costsz and Consequences of the Health Care Law. Cato Institute. White Paper No. 29.
The Boards of Trustees, Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds. (2005). 2005 Annual Report of the boards of trustees of the federal hospital insurance and federal supplementary medical insurance trust funds. Center for Medicare and Medicaid Services. http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/Downloads/tr2005.pdf. Accessed 21 May 2012.
The Boards of Trustees, Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds. (2012). 2012 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds. Center for Medicare and Medicaid Services. http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/Downloads/TR2012.pdf. Accessed 21 May 2012.
The Henry J. Kaiser Family Foundation. (2011). Employer Health Benefits 2011 Annual Survey. Kaiser Family Foundation and Health Research and Educational Trust. http://ibpis.com/blog/wp-content/uploads/2012/05/2011-KFF.pdf. Accessed 20 March 2012.
The Henry J. Kaiser Family Foundation. (2011). Women’s Health Insurance Coverage Fact Sheet. http://www.kff.org/womenshealth/upload/6000-091.pdf. Accessed 27 March 2012.
Woolhandler, S., Campbell, T., Himmelstein, D. U. (2003). Cost of Health Care Administration in the United States and Canada. New England Journal of Medicine, 349, 768–775. http://www.nejm.org/doi/full/10.1056/NEJMsa022033.
World Health Organization. (2000). The World Health Report 2000, Health Systems: Improving Performance. http://www.who.int/whr/2000/en/whr00_en.pdf. Accessed 6 March 2012.
Yelowitz, A. (2006). Pay-or-play health insurance mandates: Lessons from California. Public Policy Institute of California. http://www.ppic.org/content/pubs/cep/EP_1006AYEP.pdf. Accessed 24 March 2012.
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Tanner, M. The Patient Protection and Affordable Care Act: A Dissenting Opinion. J Fam Econ Iss 34, 3–15 (2013). https://doi.org/10.1007/s10834-013-9350-7
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DOI: https://doi.org/10.1007/s10834-013-9350-7