U.S. Health Care Policy
How can the U.S. provide access to affordable health insurance for all Americans?
How We Are Meeting the Challenge
- Assessing the impact of changes to the Affordable Care Act
- Estimating the cost and coverage effects of supplementing the current system with a single option or Medicare buy-in plan or replacing with a single payer alternative
- Understanding and contributing to policies for improving quality and access in the Medicare program, the largest U.S. health care insurer
The COVID-19 pandemic has exposed vulnerabilities in the U.S. health insurance system—in particular, the risks of linking health insurance to employment. According to the Kaiser Family Foundation, as many as 27 million Americans who lost their jobs also lost their employer coverage. This development points to the need for strengthening safety net options for Americans to get coverage elsewhere as well. RAND experts have commented on how COVID-19 is affecting the health care system and how to strengthen coverage options and the system writ large in a post COVID-19 health landscape.
The ACA's individual market exchanges are the main alternative to employer coverage for adults under 65. Yet the future of the ACA is uncertain: The U.S. Supreme Court is set to rule on the ACA’s constitutionality. RAND experts suggest that if the court strikes down the law and millions of Americans lose insurance during the pandemic, the rate of coronavirus transmission could rise and the already heavy burden on hospitals and doctors could increase. Using RAND’s COMPARE microsimulation model, RAND analysts have also estimated the effects of refinements to the ACA—such as adding a public option—and alternative models, such as single payer approaches.