The Past and Future of the Affordable Care Act

Abstract

But he also stresses the lesson of appreciating pragmatism in legislation and implementation. That is a good lesson, yet it does not contradict the importance of also being guided by philosophical principle. If it were a separate economy, the US health system would be equivalent to the fifth or sixth largest economy in the world. It is both pragmatic and principled to recognize that achieving agreement on how to redesign an economy that large, or to do it successfully in 1 piece of legislation, is beyond the capabilities of the federal government. That is why core parts of the ACA need to be reassessed and revised and why empowering the US system of federalism to adapt and experiment with the law is so important.

Can biosimilars help achieve the goals of US health care reform?

“…Following the introduction of the ACA, ~20 million additional Americans gained health insurance 2,3,13,14. The ACA-related reforms, including transformed health care payment systems, contributed to a sustained period of slow growth in per-enrollee health care spending 2.…”

“…Some insurance companies (eg, Dartmouth17 and UnitedHealthcare18) are dropping out of “ObamaCare” exchanges, as these are viewed as financially unattractive, and key stakeholders are withdrawing from the ACO market. Expanded health insurance coverage of high-risk patients and pressure to reimburse expensive cancer treatments and immunotherapy-based therapies have resulted in costs that have not been offset by enrollment of less expensive younger healthier patients, which has been low 14. In order to manage costs, health plans may consolidate, which would reduce competition and potentially drive up prices for consumers.…”

“…In the broadest sense, the economic environment may impact health care costs 13. In past economic slowdowns, spending on new and expensive technologies, particularly those with uncertain benefits, was scaled back 14. These reductions occurred even before ACA cost initiatives changed perceptions and spending behavior by highlighting the importance of health care cost 3.…”

Decision Making on Medical Innovations in a Changing Health Care Environment: Insights from Accountable Care Organizations and Payers on Personalized Medicine and Other Technologies

“…(2, 3) The Accountable Care Organization (ACO) model, first introduced in 2006 as a means to shift accountability from the individual provider to the organization level,(4) emerged in the health reform era as a mechanism for achieving the Triple Aim and health system transformation. (3, 5) An ACO is a provider-led organization with a strong base of primary care, collectively accountable for quality and per capita costs across the full continuum of care. (6) In 2012, the Centers for Medicare and Medicaid Services (CMS) launched two ACO initiatives - the Pioneer ACO Model and the Medicare Shared Savings Program (MSSP).…”

“…(14–18) Nevertheless, adoption of the ACO model by payers and health systems continues to gain momentum. (5, 19–21)…”