Supreme Court Upholds the Affordable Care Act: What the Experts Are Saying

With most of the key provisions of the Affordable Care Act upheld, we expect close to 30 million Americans to gain health insurance coverage. Yet the part of the ruling dealing with Medicaid is significant. We don't know how many states will respond, and it will take thoughtful, quantitative analysis to gain insight into this. Our next challenge will be to analyze the effects of states opting out of Medicaid expansion, and how this might influence insurance coverage, exchange enrollment, and federal spending on subsidies.

— Christine Eibner, economist

• The Effect of the Affordable Care Act on Enrollment and Premiums, With and Without the Individual Mandate

The focus now returns to implementation. A key issue for implementation—and ultimately the success or failure of the ACA—is whether or not our health care system can successfully realign to produce higher value at lower cost. RAND has generated high-impact research on this question for 40 years, and we are actively engaged in a wide range of projects of immediate relevance to the issue. The stakes are so high—millions of lives and literally trillions of dollars—that failure is not an option.

— Arthur Kellermann, Paul O'Neill Alcoa chair in policy analysis

• How Does Growth in Health Care Costs Affect the American Family?

As federal and state policymakers move to implement the ACA, there are a plethora of decisions that must be made about how to structure the program elements. These decisions and the evolution of health care reform can be improved by the independent, objective analyses that RAND can provide. We can help identify best approaches to program design and implementation, and how to assess the impact of the ACA in achieving better quality, lower costs, and improved health. RAND's work in the area of pay-for-performance and value-based purchasing is one example of how RAND is helping policymakers design incentive programs to improve quality and lower costs.

— Cheryl L. Damberg, senior policy researcher

• Taking Stock of Pay-for-Performance: A Candid Assessment from the Front Lines
• Toward a Culture of Consequences Performance-Based Accountability Systems for Public Services

The ACA contains a myriad of provisions to reduce health care costs and improve quality independent of the mandate. For example, reforms have advanced primary care in ‘patient-centered medical homes’ and ‘bundled payments’ for common episodes of care have been taking root, but could potentially accelerate in the private sector with federal funding confirmed. Now that the uncertainty of the Supreme Court decision has been lifted, transformation of health care delivery can move rapidly ahead.

— Peter Hussey, policy researcher

• Payment Reform: Analysis of Models and Performance Measurement Implications
• The PROMETHEUS Bundled Payment Experiment: Slow Start Shows Problems in Implementing New Payment Models

The passage of the law and this ruling are the start of health care reform, not the end. There are now many decisions to be made. State governments need to make preparations for the insurance exchanges and the expansion of Medicaid. Health insurance companies must ensure their offerings are in compliance with the law. Businesses should assess the impact of the new options on their employees to determine if they should continue to offer health insurance. Health care providers need to assess whether they have the capacity to provide care to as many as 30 million newly insured Americans. Finally, individuals should look at the new options that will be open to them in 2014.

— Carter C. Price, mathematician

• Small Firms' Actions in Two Areas, and Exchange Premium and Enrollment Impact
• How Will the Affordable Care Act Affect Employee Health Coverage at Small Businesses?