Congress must decide whether to eliminate the ACA and replace it with a different system, or change the ACA to meet different political goals. Extensive RAND research offers insights about the likely impact of repealing or revising the ACA along key dimensions, including Medicaid, the individual mandate, effects on employers, tax subsidies, changing rate regulations, and essential health benefits. We have also explored effects of alternatives to the ACA, including a single payer system.
Recent changes to the Affordable Care Act, including the elimination of the individual mandate penalty, may reduce enrollment in the individual market. But even with these changes, options exist for increasing health coverage.
The U.S. Department of Defense (DoD) and U.S. Department of Veterans Affairs (VA) both use private-sector contracts—known as "purchased care"—that govern how beneficiaries see community-based health providers. How feasible is it to integrate the VA and DoD approaches to purchased care?
It is difficult for physicians to keep up with changing payment models, navigate complexity, and invest in data and reporting. Slowing the rate of change and simplifying payment models can help physicians improve patient care and earn financial benefits.
Lack of insurance has been a barrier to mental health treatment for young adults. The ACA's Dependent Care Expansion, which allows them to stay on their parents' policies until age 26, has increased use of mental health care among this high need group—without affecting quality of care or disparities in access.
In 2019, the ACA's individual mandate penalty will be eliminated. How will this affect New York's nongroup insurance market? It could result in an estimated 23 to 25 percent increase in premiums and a 37 percent reduction in enrollment.